Written by Amanda Adsett, MSc, R.SLP, S-LP(C)
Think back to your graduate training. Most of us learned the classic framework of the oral and pharyngeal phases of swallowing. But what happened once the bolus passed the upper esophageal sphincter?
For many of us, that area remained a gray zone and a separate territory left entirely to gastroenterology. Through clinical experience, however, we quickly learn that this siloed view fails the children we treat. Swallowing is not a set of isolated phases. It is a continuous, multiphase, and deeply interconnected physiologic process.
In pediatric feeding and dysphagia practice, ignoring the esophagus leaves a critical blind spot. A disruption in the distal phase of the swallow can alter the pressure, clearance, and safety of the proximal phase. In pediatrics, the picture becomes even more complex as children can’t always describe what they feel. Instead, swallowing issues may disguise themselves as feeding challenges such as food refusal, prolonged mealtimes, texture aversions, or shifts in behavior around eating. These patterns change and evolve alongside the child’s growth and development, making the clinical picture even more nuanced.
When Knowledge Gaps Affect Care
In an excellent ASHA Leader article, dysphagia experts James Coyle, Liza Blumenfeld, and Lisa Evangelista emphasized that clinical growth depends on acknowledging what we don’t know. They describe harm by omission as the unintended consequences that occur simply because of gaps in our knowledge. When we don’t fully grasp the interdependence of the aerodigestive tract, we may target a feeding behavior or a pharyngeal symptom with a specific therapeutic strategy, completely unaware that we are working against an underlying gastrointestinal or motility issue.
As feeding therapists and dysphagia clinicians, we are uniquely positioned to prevent that harm. We observe feeding and swallowing in real time. We integrate complex medical histories and listen to caregiver concerns to put the puzzle pieces together. Working alongside physicians and the broader medical team, we help inform when feeding presentations may warrant further medical evaluation.
Filling the Gap
This gap in our esophageal knowledge is exactly what Beyond the Oropharynx: Integrating Esophageal Knowledge into Pediatric Feeding Practice, a new course available through Education Resources, was designed to address. It provides foundational knowledge of the esophagus and commonly encountered conditions, along with strategies for recognizing symptom patterns and knowing when and how to refer. The course also covers evidence-informed therapeutic interventions and guidance on contributing within multidisciplinary care teams.
Staying Curious for the Children We Serve
We owe it to our patients and their families to maximize our clinical knowledge and approach their care with intellectual curiosity. To borrow from the wisdom of Coyle, Blumenfeld, and Evangelista, let’s stay hungry, enthusiastic, and humble as we continue to learn and advance the care we provide.
Upcoming Live Webinar Dates
Beyond the Oropharynx: Integrating Esophageal Knowledge into Pediatric Feeding Practice
Sources:
Evangelista, L., Blumenfeld, L., & Coyle, J. (2022, March 9). How do we cultivate critical thinking in dysphagia decision‑making? The ASHA LeaderLive. https://leader.pubs.asha.org/do/10.1044/leader.FTR1.27032022.36/full/