In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Nikhila Raol, pediatric otolaryngologist at Children’s Healthcare of Atlanta and associate professor at Emory University, discuss management of pediatric dysphagia.

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SHOW NOTES

First, Nikhila explains her educational background, starting from training in Texas to going to Atlanta to join Children’s Healthcare of Atlanta. Previously, she spent time in Boston getting her Masters of Public Health because she wanted to develop a niche focused on population health. This degree then sparked the idea of focusing on swallowing disorders in the pediatric population.

Then, Nikhila delves into how a child with dysphagia usually presents. These children typically have issues with breastfeeding, coughing, choking, and may even refuse food. In older children, they usually bring forth issues to their parents to prompt evaluation. Nikhila also mentions the close relationship she has with speech-language pathologists, as they are another big source of referrals. Red flags to pay attention to in young children with dysphagia include weight loss and nasal congestion.

Next, Nikhila and Gopi discuss physical examination techniques. Nikhila looks at the nasal passages to assess for congestion. She also provides advice for dealing with children less than 3 months of age, which includes prescribing a 3-5 day trial of dexamethasone drops to see if nasal congestion is the reason for reflux issues. She also mentions the value of involving GI colleagues to broaden her workup of complicated patients. The episode concludes with a discussion on how to choose between various treatment modalities such as botox injections and surgery, and Nikhila’s Fulbright project happening in India.