toddler with dysphagia

[icdrd]

My 2.5 y.o. daughter has had pronounced feeding difficulties since birth and FTT.  She chokes and gags when she eats, about 70-80% of the time.  However, sometimes she is just fine.  She has been evaluated for mechanical problems, has had ankylglossia repaired and they have ruled out dysphagia lusoria due to her aberrant right subclavian artery. No marked improvement from speech therapy.  Docs now think possibly neurologic.  Would a neurologic cause present as intermittent?  No noticeable facial palsy, however, she has had 2 seizures (but normal EEG's a few days later), has sleeping difficulties, and often wakes up screaming in pain in the middle of the night with no discernable cause (if that helps...).  She doesn't appear to have any developmental or cognitive delay.  I just need to know if this is an avenue I should check, she has so many problems I don't know where to go first.  Thanks in advance for any response.  

[DrNoopurMD]

Hi,
How are you?
It is a very unusual case and is very difficult to diagnose without proper clinical examination.
Some of the neurologic causes of dysphagia in children are nerve injury, brain injury, brain tumors, developmental delay, muscular dystrophy and poor functioning of muscles of tongue and oesophagus.
Please consult an experienced neurologist and do keep us posted!

[nelmsy]

Hi, I am 28 and also have an aberrant right subclavian artery that causes dysphagia lusoria.  In many cases, there are no symptoms throughout the course of a lifetime.  Approximately .5% of the population has the defect, but usually go undiagnosed due to zero symptoms.  It truly sounds as if your daughter is having complications from this.  There is an intense pain that occurs called retrosternal pain (pain in the middle of chest) and even in the upper back from the disorder.  I actually choke and gag when I eat and at other times am fine.  This is because the esophagus is moving and sometimes has stronger effects from the vessel that is compressing it.  I suggest you get a second opinion and consult a cardiothoracic sugeon.  
I can say that anxiety is associated with this, but many times not so much mental but physical.  The area effected has a lot of pain receptors and is very sensitive.  I hope this helps!