# Electrical Stimulation May Improve the Feeding and Nutritional Status of Children with Dysphagia
## 5 Treatment of Dysphagia  
Dysphagia therapy for children is a complex process that requires the use of various strategies and interventions tailored to the individual condition and capabilities of the patient. Before starting them, it is important to diagnose the problem [2,8,18,23]. The diagnosis includes a medical interview and an analysis of the child's health history, includingprevious swallowing problems, neurological diseases, anatomical congenital defects, and other risk factors. Another diagnostic element is observation during eating, how the child eats food, paying attention to swallowing problems, coughing, hiccups, and other diagnostic elements. Furthermore, it is essential to investigate the function of the vocal organ and how it affects the capacity to swallow [21]. The treatment of dysphagia is based on an individual plan. The goal of the treatment is to ensure the safety, hydration, and nutrition of children and to remove the cause of dysphagia if possible. In some cases, it is possible to remove the cause of swallowing disorder, such as by relaxing the esophageal sphincter, which is too tight [24]. However, if the cause cannot be removed, dysphagia treatment may focus on making swallowing safer and relieving discomfort. Treatment can include drugs, swallowing therapy, dietary modification, surgery, and other treatments, depending on the cause [8; 21]. Drugs may be effective in relieving some symptoms of dysphagia or some of its causes, such as infection [59]. However, dysphagia therapy usually focuses on strengthening the muscles to improve swallowing motor abilities and reduce the chance of choking or aspirating. Exercises are designed to develop or improve oral motor skills, such as chewing and swallowing. Physical motor techniques in dysphagia therapy include manual and mechanical motor exercises that strengthen the muscles involved in swallowing, including exercises for the tongue, lips, and pharyngeal muscles (in the area of a range of motion or strength) [8]. This therapy is usually provided by neuro speech therapists also known as a speech-language pathologist (SLP) or neurologogpedist who specializes in treating communication and swallowing disorders caused by neurological conditions [2; 8]. Swallowing exercises include, but are not limited to, tongue strengthening exercises, laryngeal exercises, and mouth closing exercises to increase lip strength and mouth closure. Swallowing training may be helpful for patients with dysphagia caused by neurologic disorders or for those who have had surgery on the pharyngeal muscles [2; 13]. Some cases of dysphagia require surgical intervention [60]. In the case of achalasia, peroral endoscopic myotomy (POEM) is one of the surgical procedures for swallowing disorders [8; 60]. This involves cutting through the tight ring of muscle to make it loosen. A diverticulectomy may be needed to remove a diverticulum in the esophagus. Another procedure entails dilation of the esophagus to gently expand the narrowed regions. Sometimes, an esophageal stent is needed to keep the narrowed esophagus open. If there is a tumor or other obstructing factor, surgery is needed to remove it [8]. For anatomical defects, such as a cleft palate, surgical repair can also eliminate the cause of the swallowing problem [53]. Dietary modification can help make swallowing safer and more comfortable if the direct cause of dysphagia cannot be eliminated [61; 62]. The main methods used in this regard are the elimination of foods that cause difficulty swallowing or the adjustment of their consistency and portion sizes to ensure the safe feeding of the child [2; 8; 18]. A convenient consistency of the diet should be established, such as puree, mechanically modified foods, solid foods, or only semi-solid foods [1]. The use of thickeners in liquid diets is also considered to minimize the risk of inhaling food into the lungs and choking [16; 63].