Acute Dysphagia in Children
🔑 Key concept
- Dysphagia
= symptom (not diagnosis) →
อาจเป็น life-threatening
- ต้องประเมิน airway →
infection →
obstruction →
neurologic
- Priority
= airway + aspiration prevention
🚨 Step 1: Immediate
assessment (critical)
🔥 Signs of airway
compromise
- drooling
- stridor
- respiratory
distress / retractions
- aphonia
/ “hot potato voice”
- cyanosis
👉 จัดเป็น
emergency →
airway first (oxygen + intubation if needed)
🧠 Step 2: Categorize (ช่วย narrow diagnosis)
1. Dysphagia + fever
👉 คิดถึง
infection / inflammation
2. Dysphagia without fever
👉 คิดถึง
obstruction / injury / neurologic
🔍 Step 3: Differential
diagnosis (high-yield)
🚨 Life-threatening causes
(ต้อง exclude ก่อน)
1. Upper airway infection
- Epiglottitis
- Retropharyngeal
abscess
- Peritonsillar
abscess
👉 clue:
- drooling
+ neck stiffness + fever
- hot
potato voice
- trismus
2. Esophageal injury
- Foreign
body (esp. button battery ⚠️)
- Caustic
ingestion
- Esophageal
perforation →
mediastinitis
👉 clue:
- acute
onset
- chest
pain / drooling
- severe
distress
👉 button battery → remove within 2 ชั่วโมง
3. CNS / neuromuscular
- meningitis
/ encephalitis
- brain
tumor
- botulism
/ tetanus / GBS
👉 clue:
- altered
mental status
- cranial
nerve deficit
🧩 Common causes
1. Infection
- pharyngitis
- stomatitis
(HSV, enterovirus)
- tonsillitis
2. Esophagitis
- GERD
- pill
esophagitis
- eosinophilic
esophagitis (EoE)
3. Trauma
- oropharyngeal
injury
4. Functional / motility
- achalasia
- dystonic
reaction (ยา)
🧪 Step 4: History (key
questions)
- foreign
body ingestion?
- caustic
ingestion?
- medication
(doxycycline, NSAIDs)?
- fever
/ neck pain?
- neurologic
symptoms?
- solids
vs liquids
👉 solids > liquids → obstruction
👉
solids + liquids → motility
disorder
🩺 Step 5: Physical exam
- airway
+ respiratory status
- oral
cavity / pharynx (mass, ulcer, infection)
- neck
(swelling, LN)
- neuro
exam (CN V, VII, IX, X, XII)
- lung
→ aspiration
🧪 Step 6: Investigation
1. Imaging (first-line)
- Neck
X-ray
- Chest
X-ray
👉 หา:
- foreign
body
- air
(perforation)
- mass
/ airway compression
2. CT scan
- suspected
abscess / mediastinitis
- suspected
tumor
3. Endoscopy
- foreign
body
- caustic
ingestion
- esophagitis
4. Manometry
- suspected
achalasia
⚠️ Key diagnosis clues (จำง่าย)
|
Finding |
Diagnosis |
|
drooling + stridor |
epiglottitis |
|
hot potato voice + trismus |
peritonsillar abscess |
|
neck stiffness + pain extension |
retropharyngeal abscess |
|
acute dysphagia |
foreign body |
|
severe chest pain + shock |
perforation |
|
solids > liquids |
obstruction |
|
solids + liquids |
motility |
💊 Management (principle)
1. Stabilization
- airway
+ breathing
- NPO
- IV
fluid
2. Specific treatment
|
Condition |
Treatment |
|
Epiglottitis |
airway + IV antibiotics |
|
Abscess |
drainage + antibiotics |
|
Foreign body |
endoscopic removal |
|
Button battery |
emergency removal |
|
Caustic ingestion |
endoscopy |
|
Perforation |
surgery + antibiotics |
|
Infection |
targeted therapy |
📌 Clinical pearls
- เด็ก dysphagia →
คิด airway ก่อน diagnosis เสมอ
- Drooling
= red flag
- Button
battery = true emergency
- Dysphagia
+ fever → infection
until proven otherwise
- Dysphagia
+ neuro sign → CNS
cause
🧾 Algorithm (ใช้จริงใน ER)
1.
Airway compromise? → stabilize
2.
Fever?
o Yes
→ infection (epiglottitis /
abscess)
o No
→ obstruction / ingestion /
neurologic
3.
Acute onset →
foreign body until proven otherwise
4.
Imaging →
X-ray ± CT
5.
Endoscopy / specialist consult
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