Dysphagia means having difficulty swallowing food, liquids or saliva. Dysphagia can happen when the muscles or nerves involved in swallowing do not work together normally or when there is a problem with the esophagus, the tube that carries food from the mouth to the stomach.

Symptoms

Dysphagia can make eating and drinking uncomfortable or unsafe. Depending on the cause, your child may:

• Cough, gag or choke while eating or drinking
• Feel like food is stuck in the throat or chest
• Take a long time to eat
• Avoid certain foods or textures
• Have pain or discomfort when swallowing
• Regurgitate food after swallowing
• Have difficulty gaining weight

How we evaluate your child

We start by learning when your child has trouble swallowing and whether symptoms occur with liquids, solid foods or both. Depending on your child’s symptoms, testing can help us understand how food moves through the esophagus.

Your child may need imaging, an endoscopy to look inside the esophagus or esophageal manometry, a test that measures how well the muscles of the esophagus squeeze and move food toward the stomach.

Treatments

Treatment depends on what is causing your child’s swallowing difficulty. Care may include treating an underlying digestive condition, changing how or what your child eats, medications or therapies that help improve swallowing.

When a motility disorder is contributing to dysphagia, treatment focuses on helping food move more safely and effectively through the esophagus.

Encopresis, also called soiling, is repeated stool leakage or stool accidents in a child who is past toilet-training age. It is often related to long-standing constipation and stool buildup.

When stool remains in the rectum for a long time, the rectum can stretch and your child may have difficulty recognizing when they need to have a bowel movement. Liquid stool can then leak around the built-up stool.

Symptoms

Children with encopresis may experience:

• Stool accidents or soiled underwear
• Chronic constipation
• Hard or very large stools
• Belly pain or bloating
• Stool withholding
• Reduced awareness of the need to have a bowel movement

How we evaluate your child

We’ll talk with you and your child about bowel habits, stool accidents, toilet routines and previous treatments for constipation.

When symptoms are severe or do not improve with standard treatment, specialized testing may help us understand how the colon, rectum, muscles and nerves involved in bowel movements are working.

Treatments

Treatment focuses on removing built-up stool and helping your child establish regular, predictable bowel movements. This may include:

• A bowel cleanout
• Medications to keep stool soft and moving
• Scheduled bathroom visits
• Nutrition and hydration changes
• A personalized bowel management plan
• Referral to additional services such as physical therapy, occupational therapy or behavioral health.

For children with more complex symptoms, treatment may also address an underlying motility problem affecting how stool moves through the bowel.

Esophageal achalasia is a rare motility disorder that makes it difficult for food and liquids to move from the esophagus into the stomach. Normally, a ring of muscle at the bottom of the esophagus relaxes when your child swallows. With achalasia, this muscle does not relax properly and the esophagus may also have difficulty pushing food downward.

Symptoms

Symptoms of esophageal achalasia may develop gradually and can include:

• Difficulty swallowing food or liquids
• Feeling like food is stuck
• Regurgitation of undigested food
• Chest pain or discomfort
• Coughing, especially at night
• Poor appetite
• Weight loss or difficulty gaining weight

How we evaluate your child

Testing helps us determine how well the esophagus moves food and whether the muscle at the bottom is relaxing normally.

Esophageal manometry, a test that measures muscle contractions and pressure inside the esophagus, is an important tool for diagnosing achalasia. Your child may also need imaging or an endoscopy to look at the esophagus and rule out other causes of swallowing difficulty.

Treatments

Treatment for achalasia focuses on helping the muscle at the bottom of the esophagus open so food and liquids can move more easily into the stomach.

Depending on your child’s needs, treatment may include procedures that stretch or open the tight muscle or surgery to carefully divide the muscle. Our gastroenterology and surgical teams work together to determine the best treatment for your child.

Gastroparesis, also called delayed stomach emptying, is a motility disorder in which the stomach takes longer than normal to move food into the small intestine. There is no physical blockage. Instead, the muscles or nerves that control stomach movement do not move food forward as expected.

Symptoms

Because food remains in the stomach longer, children with gastroparesis may experience:

• Nausea
• Vomiting
• Feeling full after eating only a small amount
• Bloating
• Belly pain
• Poor appetite
• Weight loss or difficulty gaining weight

Symptoms can make it difficult for some children to get enough nutrition and may interfere with school, activities and everyday life.

How we evaluate your child

We’ll review your child’s symptoms, nutrition, medications and medical history. Testing may be needed to rule out a physical blockage or another digestive condition.

A gastric emptying study may be used to measure how quickly food leaves your child’s stomach. During this test, your child eats a small meal containing a safe amount of material that can be tracked as it moves through the stomach.

Treatments

Treatment focuses on helping your child get the nutrition they need, reducing symptoms and improving stomach emptying when possible.

Treatment may include:

• Smaller, more frequent meals
• Nutrition changes
• Medications to reduce nausea or help the stomach empty
• Nutrition support when eating enough becomes difficult

For children with severe gastroparesis, our team may recommend additional treatments based on the cause and severity of symptoms.

Hirschsprung disease is a condition present at birth in which nerve cells are missing from part of the large intestine. These nerve cells normally help the muscles of the bowel move stool forward. Without them, stool can become backed up and cause severe constipation or a blockage.

Symptoms

Symptoms often begin shortly after birth but may sometimes become apparent later. Signs may include:

• Not passing the first bowel movement soon after birth
• A swollen belly
• Vomiting
• Severe or ongoing constipation
• Difficulty feeding
• Poor weight gain

Some children continue to have constipation or difficulty emptying their bowels even after treatment for Hirschsprung disease.

How we evaluate your child

Hirschsprung disease is typically diagnosed using a rectal biopsy, a test that takes a very small tissue sample from the rectum to look for the nerve cells that are missing in the condition.

For children who continue to have bowel problems after surgery, motility testing can help us understand how the remaining bowel, rectum and muscles involved in having a bowel movement are functioning.

Treatments

Most children with Hirschsprung disease need surgery to remove the section of bowel without normal nerve cells and connect the healthy bowel to the anus.

If constipation or other bowel problems continue after surgery, treatment may include medications, bowel management or other therapies based on how your child’s bowel is functioning.

Irritable bowel syndrome (IBS) is a condition that causes recurring belly pain along with changes in bowel movements, such as diarrhea, constipation or both. IBS is a disorder of gut-brain interaction, meaning the digestive system and brain communicate differently even without visible inflammation or damage to the intestine.

Symptoms

Symptoms of IBS can come and go and may be affected by foods, stress, sleep and other factors. Your child may experience:

• Recurring belly pain or cramping
• Diarrhea
• Constipation
• Alternating diarrhea and constipation
• Bloating
• Changes in how often they have bowel movements
• Changes in the appearance of their stool

IBS can affect school, sports, sleep and other daily activities even though it does not damage the digestive tract.

How we evaluate your child

There is no single test for IBS. We start by looking at your child’s symptoms, bowel habits, medical history and growth.

Testing may be recommended when needed to rule out inflammatory bowel disease, celiac disease or other digestive conditions that can cause similar symptoms.

Treatments

Treatment is individualized based on your child’s symptoms and what seems to trigger them. Care may include:

• Nutrition changes
• Medications for diarrhea or constipation
• Strategies for managing belly pain
• Regular sleep and activity
• Behavioral health therapies that support the gut-brain connection

Our goal is to help your child manage symptoms and participate more comfortably in everyday life.

Pediatric intestinal pseudo-obstruction (PIPO) is a rare and serious motility disorder in which the intestines act as though there is a blockage even though no physical blockage is present. Problems with the muscles or nerves of the intestine prevent food, fluid and waste from moving through the digestive tract normally.

Symptoms

Symptoms can vary depending on which parts of the digestive tract are affected. Children may experience:

• Severe belly swelling or bloating
• Belly pain
• Nausea or vomiting
• Constipation
• Difficulty tolerating food or feedings
• Poor weight gain or growth
• Symptoms that resemble a bowel blockage

How we evaluate your child

Diagnosing pediatric intestinal pseudo-obstruction often requires several types of testing. Imaging can help us rule out a physical blockage and look at the shape and size of the intestines.

Your child may also need specialized motility testing to measure how the muscles and nerves of the digestive tract are working. Because PIPO can affect nutrition and other body systems, several pediatric specialists may be involved in the evaluation.

Treatments

Treatment focuses on helping food and waste move through the digestive system, relieving symptoms and making sure your child receives enough nutrition.

Depending on your child’s needs, treatment may include:

• Medications that help the digestive tract move
• Nutrition and hydration support
• Tube feeding when needed
• Intravenous nutrition for children who cannot absorb enough nutrition through the digestive tract
• Procedures or surgery for certain complications

Children with PIPO often need ongoing care from a multidisciplinary team.

Rumination syndrome is a disorder of gut-brain interaction in which recently eaten food comes back up into the mouth shortly after eating. Unlike vomiting, it usually happens without nausea, retching or feeling sick. The food may be rechewed, reswallowed or spit out.

Rumination is not something a child is doing intentionally. It happens when the abdominal muscles contract in a learned pattern after eating.

Symptoms

The main symptom is repeated regurgitation of food soon after meals. Children may also experience:

• A feeling of pressure or discomfort before food comes back up
• Rechewing or reswallowing food
• Feeding or eating difficulties
• Weight loss or difficulty gaining weight
• Avoiding meals or eating around other people

How we evaluate your child

We’ll talk with you and your child about when regurgitation happens and what it feels like. The pattern of symptoms often helps us identify rumination syndrome.

Testing may be recommended to rule out reflux, swallowing problems, gastroparesis or another digestive condition when the diagnosis is unclear.

Treatments

Treatment focuses on retraining the way the abdominal muscles respond after eating. Diaphragmatic breathing, a breathing technique that uses the large muscle beneath the lungs, can help interrupt the muscle pattern that causes food to come back up.

Treatment may also include behavioral therapy, nutrition support and strategies for managing symptoms around meals. Families often work with gastroenterology, behavioral health and nutrition specialists as part of treatment.

Severe constipation is constipation that is persistent, causes significant symptoms or does not improve with standard treatment. While most childhood constipation is not caused by a motility disorder, specialized evaluation can help determine whether problems with the muscles, nerves or movement of the bowel are contributing to ongoing symptoms.

Symptoms

Children with severe constipation may experience:

• Infrequent bowel movements
• Hard, large or painful stools
• Significant straining
• Belly pain or bloating
• Stool withholding
• Stool accidents
• Difficulty completely emptying the bowel

How we evaluate your child

We start by reviewing your child’s bowel habits, nutrition, medications, previous treatments and medical history.

When constipation continues despite treatment, specialized motility testing may help us understand how stool moves through the colon and how the rectum and muscles involved in having a bowel movement are working.

Treatments

Treatment is based on what is causing your child’s constipation and how their bowel is functioning. Options may include:

• A bowel cleanout to remove built-up stool
• Medications to keep stool soft and moving
• Nutrition and hydration changes
• Regular bathroom routines
• Bowel management
• Therapies that help your child coordinate the muscles used for bowel movements
• Referral to additional services such as physical therapy, occupational therapy or behavioral health.

For children with severe or complex constipation, we adjust treatment based on their response and the results of motility testing.

A pediatric motility disorder affects how food, liquids or waste move through a child’s digestive system. Motility depends on muscles and nerves working together to move food from the esophagus to the stomach, through the intestines and eventually out of the body.

When this movement is too slow, too fast or does not happen normally, children can develop symptoms such as difficulty swallowing, nausea, vomiting, bloating, belly pain, constipation or difficulty eating.

Your child may benefit from a pediatric motility evaluation when digestive symptoms are severe, continue despite standard treatment or suggest that food or stool is not moving normally through the digestive tract.

A motility specialist may also be helpful for children with persistent swallowing problems, gastroparesis, severe constipation, intestinal pseudo-obstruction or ongoing bowel problems after treatment for conditions such as Hirschsprung disease.

Testing depends on your child’s symptoms and which part of the digestive system may be affected. Your child may need imaging, endoscopy or tests that measure how quickly food or stool moves through the digestive tract.

Specialized tests may include manometry, which measures the pressure and muscle contractions inside part of the digestive tract, or a gastric emptying study to measure how quickly food leaves the stomach. We choose testing based on your child’s individual symptoms rather than using the same tests for every child.

Manometry is a specialized test that measures muscle contractions and pressure inside the digestive tract. It can help us understand whether the muscles and nerves responsible for moving food or stool are working together normally.

Different types of manometry can evaluate different parts of the digestive system. For example, esophageal manometry evaluates swallowing and movement through the esophagus, while other forms of manometry can help evaluate how the colon or rectum is functioning.

Most constipation in children is not caused by a motility disorder. However, specialized evaluation may be helpful when constipation is severe, has been present for a long time or does not improve despite appropriate treatment.

Motility testing can help us understand how stool moves through the colon and whether the nerves and muscles involved in having a bowel movement are working properly. The results can help us choose a treatment based on the underlying problem.

Yes. Treatment depends on which part of the digestive system is affected and what is causing the motility problem. Care may include nutrition changes, medications, bowel management, feeding support, behavioral therapies, procedures or surgery.

Some motility disorders require ongoing care, while others can improve significantly with treatment. Our goal is to reduce symptoms, support nutrition and growth and help your child participate more comfortably in everyday life.

It depends on the condition. Some children need specialized motility care for a limited period, while children with chronic or complex disorders may benefit from ongoing follow-up.

As your child grows, symptoms and treatment needs can change. We continue to monitor their digestive function, nutrition and growth and adjust treatment to support their needs over time.