Do silent reflux and underdeveloped lungs cause swallowing difficulty?
Patient: I have a 2yr old that has refused to swallow for several days now. I took her to her PCP and they just did a standard run through. They sent me home saying probably the weather change. Today I told her to stick her tongue out so I could see how her throat looked. I was extremely panicked to see her epiglottis. Is this normal? Ive never seen it before , also I have 3 other children and Ive never seen anything like this appear out of no where. Im quite certain it wasnt there before as she has had a swallow study and camera run through her nose by an ENT and they didnt say anything about this. Only diagnosis she had at that time was underdeveloped rings which improved with age and silent reflux which also imporved. Is this normal and could this be the reason she wont eat ? Doctor: Hello and Welcome to "Ask A Doctor" service.  I have reviewed your query and here is my advice. Yes, her epiglottis has always been just below her throat and above her vocal cords in the same position as the epiglottis in your other children.  In my experience as a pediatrician when peering into the open mouth of a child, I have often seen their epiglottis.  For the most part these have been young, healthy children and I was looking into their mouth and throat as part the routine physical exam.  The children had opened their mouths very wide.  In each of these patients the epiglottis was normal. Has she ever refused to swallow before?  Does she have fast, labored breathing?  Is she able to swallow her saliva?  My suspicion as to why your infant won't swallow is that it is probably due to silent reflux.  A patient who has silent reflux has a backup of stomach acid into their throat, esophagus, and larynx.  Also, area below the vocal cords may be narrowed.  Somewhere in this part of her upper respiratory or gastrointestinal tract there may be irritation or blockage.  If she is not eating, is she drinking?  It is vital that she not become dehydrated.  I urge you to take her back to the ENT doctor as soon as possible.  Hope I have answered your query.  Let me know if I can assist you further.  Arnold Zedd, MD, FAAP