Difficulty Swallowing (Dysphagia) in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Difficulty in swallowing is also called dysphagia, and occurs when an individual has trouble getting food or liquid to pass down the mouth or throat. Some individual may gag, cough, or choke when trying to swallow, while others may feel like the food is stuck in their throat.
One cause of dysphagia can be the cancer itself, especially mouth, throat, or oesophageal cancers, which can cause the passages to become restricted or narrowed.
Dysphagia is also a common side effect of some cancer treatments, such as radiation therapy, surgery, and, less commonly, chemotherapy.
Side effects of cancer treatment that may also cause swallowing difficulties include:
- Fibrosis – scarring or stiffness in the throat, oesophagus, or mouth
- Infections of the mouth or oesophagus from radiation therapy or chemotherapy
- Mucositis – soreness, pain, or inflammation in the throat, oesophagus, or mouth. Pain associated with mucositis may worsen swallowing problems.
- Physical Changes to the jaws, mouth, oesophagus, or throat from surgery
- Swelling or Narrowing of the throat or oesophagus from radiation therapy or surgery
- Xerostomia (dry mouth) – from chemotherapy or radiation therapy may also worsen swallowing problems.
Management and Treatment
Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment, therefore it is important that you let your child’s doctor, nurse, or another member of their healthcare team know immediately if they are experiencing any difficulty in swallowing, including any new symptoms or a change in symptoms.
It is important to distinguish between feeling like food is sticking in your child’s throat and food that is going the wrong way from pain while swallowing, in order to best manage problems with swallowing.
Your child’s doctor may refer your child to a speech pathologist to teach them how to swallow more easily and avoid choking and gagging while eating and drinking. It is often better for those with cancer involving the throat to meet with a speech pathologist to begin swallowing therapy before starting cancer treatment.
If your child is experiencing painful swallowing (odynophagia), their doctor may prescribe medication to reduce inflammation and pain, including mouth rinses to be used directly before eating.
If swallowing problems make it hard for your child to eat a nutritious diet, it may be necessary for them to be fed food and/or liquids through a tube that passes through the nose or wall of the gut into the stomach until swallowing becomes easier.
Diet and Eating Tips
Different approaches may work better for some patients than for others, depending on the severity and cause of the swallowing problems. It is important that you continue to try giving your child different types of foods to ensure that they are eating a nutritious diet that contains sufficient proteins, calories, vitamins and minerals.
Try the following tips:
- Do Not give your child dry, coarse, or hard foods and foods that need a lot of chewing.
- Encourage your child to sit upright when eating or drinking.
- Encourage your child to take small bites, and chew slowly and thoroughly.
- Give your child a straw to drink liquids and soft foods.
- Give your child foods that are cold or at room temperature to help numb pain
- Give your child soft, smooth foods, such as yogurt, pudding, or ice cream to eat
- If your child is losing weight, encourage them to eat small, frequent meals; choose foods that are high in calories and protein, such as eggs, milkshakes, casseroles, and nutritional shakes.
- Mash or blend foods, or moisten dry foods with broth, sauce, butter, or milk.
- Try thickening liquids by adding gelatine, tapioca, baby rice cereal, or commercial thickening products; thicker liquids can be easier to swallow.
Meet with a speech pathologist to learn about different foods you can try that may be easiest or safest for your child to swallow and how to prepare them. Ask for a referral to meet with a registered dietitian for additional advice on eating a balanced diet.