# Electrical Stimulation May Improve the Feeding and Nutritional Status of Children with Dysphagia
## 3 Symptoms of Dysphagia  
Oropharyngeal dysphagia occurs when it is difficult to move the food bolus from the oral cavity to the esophagus [22]. The symptoms pertain to difficulties encountered in initiating the transportation of a food bolus. Factors indicating dysphagia include the need to change feeding position or equipment, the use of food and fluid texture modifications, and/or the need to use modified feeding strategies and reliance on enteral feeding or oral supplements to maintain nutritional status and/or hydration [43]. Dysphagia in children manifests various diagnostic symptoms that may not always be discernible [22; 44]. One typical symptom is the sensation that food or fluid is proving to be challenging to swallow, and that it is becoming entrapped in the esophagus or clinging to the stomach [8]. Another symptom is odynophagia, or pain during swallowing, which may occur in the throat or chest and may mimic heartburn or even cardiac symptoms [24; 37].  
Dysphagia may be accompanied by coughing during or immediately after swallowing and may be caused by food entering the throat too soon, food particles remaining in the throat after swallowing, or regurgitation of food [8; 37; 43]. Choking, which is a cough caused by food or fluid being stuck in the throat or esophagus or being aspirated into the airway, may also occur. If aspiration happens into the airways, it can lead to aspiration pneumonia [14; 24]. Another symptom of dysphagia could be regurgitation [45]. This happens when food or liquid returns to the mouth. Unlike vomiting, regurgitation occurs without gag reflexes, nausea, or involvement of the stomach muscles. Nasal regurgitation occurs when food or fluid is swallowed and regurgitates into the nose. This occurs when the nasopharynx does not close properly and may indicate a problem with the nerves that regulate the muscles of the soft palate or throat [8; 15; 24; 37].  
Dysphagia may also cause difficulty breathing while feeding a child. Wet or congested sounds may also happen. If a child makes these sounds during feeding, it may indicate that food or liquid is entering the airway or remaining in the throat, increasing the risk of airway entry [19; 46]. Coughing, gagging, or choking may also occur. Additionally, prolonged feeding time, unusually stressful mealtimes, and deteriorating anthropometric parameters are associated with dysphagia [1; 37]. Oral motor dysfunction limits bolus control, manipulation, and/or passage of liquids and solids. These include ineffective ingestion, messy eating, poor control of fluids and foods, slow or ineffective bolus formation and movement, and gag reflex [37; 40]. The symptoms may include repeated and difficult swallowing, throat clearing, nasal regurgitation, and poor airway protection [43; 46; 47; 48].  
Swallowing problems and potential respiratory complications can cause stress for both children and parents and caregivers [49]. Parents of children with dysphagia are more anxious and stressed during feeding than parents of children without dysphagia [7; 50]. [PERSON] et al. reported that parents of children with neurological problems spend an average of 3.5 h feeding, and nearly half of them describe mealtimes as stressful and not at all enjoyable [11]. Feeding stress usually involves the risk of choking, special preparation and serving of food, costs, and often additional assistance required for feeding [7; 51]. As a result of prolonged and stressful feeding, a child with swallowing problems is exposed to a lack of adequate nutrition, which can lead to malnutrition and exacerbate developmental disorders [13]. Children with dysphagia often require an increased number of hospitalizations, longer hospital stays, and repeated emergency room visits. It makes it not only stressful but also results in high medical costs, including tube feeding [51; 52]. This is a burden that adds stress to children with dysphagia and their parents [49].