00103 Impaired swallowing

00103 Impaired swallowing

Definition of the NANDA label

State in which the individual presents an abnormal functioning of the swallowing mechanism associated with a deficit of the oral, pharyngeal or esophageal structure or function.

Abnormal functioning of the swallowing mechanism associated with deficits in oral, pharyngeal, or esophageal structure or function.

Defining characteristics

Impaired pharyngeal phase

• Alteration of head positions.
• Inadequate pharyngeal elevation.
• Refusal of food.
• Unexplained fever.
• Delay in swallowing.
• Recurrent lung infections.
• Chirping voice.
• Nasal reflux.
• Choking, coughing, or nausea.
• Multiple swallows.
• Anomaly in the pharyngeal phase evidenced by swallowing study.

Impaired esophageal phase

• Heartburn or epigastric pain.
• Acid-smelling breath.
• Unexplained irritability at meal times.
• Presence of vomiting on the pillow.
• Repetitive swallowing or rumination.
• Regurgitation of gastric contents or belching.
• Bruxism.
• Cough at night or when waking up.
• Observation of evidence of difficulty in swallowing (eg, stasis of food in the oral cavity, coughing / choking).
• Hyperextension of the head, arching during or after meals.
• Abnormality in the esophageal phase demonstrated by swallowing study.
• Odynophagia.
• Refusal of food or limitation of volume.
• Complaints of “stuck high.”
• Hematemesis.
• Vomiting.

Impaired oral phase

• Lack of action of the tongue to form the bolus.
• Weakness to suck reflected in an ineffective bite.
• Incomplete closure of the lips.
• Expulsion of food out of the mouth.
• Slowed bolus formation.
• Food falling from the mouth.
• Premature bolus entry.
• Nasal reflux.
• Inability to empty the oral cavity.
• Lengthening of meals with less food consumption.
• Cough, choking, nausea before swallowing.
• Anomaly in the oral phase evidenced by a swallowing study.
• Swallowing in stages.
• Lack of chewing.
• Stagnation in the lateral grooves.
• Sialorrhea or drooling.

Related factors

Congenital deficits

• Anomalies of the upper airway.
• Inability to develop or protein malnutrition.
• States with significant hypotonia.
• Respiratory disorders.
• History of tube feeding.
• Problems with eating behavior.
• Self-injurious behavior.
• Neuromuscular impairment (eg, decreased or absent gag reflex, decreased strength or excursion of muscles involved in chewing, perceptual impairment, partial paralysis).
• Congenital heart disease.
• Mechanical obstruction (eg, edema, tracheostomy tube, tumor).
• Involvement of the cranial nerves.

Neurological problems

• Anomalies of the upper airway.
• Laryngeal abnormalities.
• Achalasia.
• Gastroesophageal reflux disease.
• Acquired anatomical defects.
• Cerebral palsy.
• Head trauma.
• Internal or external trauma.
• Tracheal, laryngeal or esophageal defects.
• Developmental delay.
• Defects of the nasal or nasopharyngeal cavity.
• Abnormalities of the oral or oropharyngeal cavity.
• Prematurity.

At risk population

• Behavioral feeding problem
• Failure to thrive
• History of enteral feeding
• Self-injurious behavior
• Developmental delay
• Prematurity

Associated condition

• Achalasia
• Acquired anatomic defects
• Brain injury
• Cerebral palsy
• Conditions with significant hypotonia
• Congenital heart disease
• Cranial nerve involvement
• Esophageal reflux disease
• Laryngeal abnormality
• Laryngeal defect
• Mechanical obstruction
• Nasal defect
• Nasopharyngeal cavity defect
• Neurological problems
• Neuromuscular impairment
• Oropharynx abnormality
• Protein-energy malnutrition
• Respiratory condition
• Tracheal defect
• Trauma
• Upper airway anomaly


• Suction control.
• Swallowing status (specify).


• Precautions to avoid aspiration.
• Swallowing therapy.
• Postural changes.