Esophageal atresia or tracheoesophageal fistula (EA/TEF) repair: How to help your child with eating

​​What is esophageal atresia or tracheoesophageal fistula (EA/TEF) repair?

EA/TEF repair is surgery within the first few days of life to correct defects in the esophagus, the tube leading from the mouth to the stomach.

How might EA/TEF repair affect my child’s eating and drinking?

After an EA/TEF repair, your child may find it difficult to swallow food and liquids (including their own saliva). This difficulty is called dysphagia.

How food usually travels through the esophagus
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When food or liquid is swallowed, it moves from the mouth into the throat (1). From there, it moves into the esophagus, where a wave of muscular contractions pushes it downwards (2). The food then passes into the stomach for further digestion (3).

Causes of dysphagia

  • Dysphagia can occur if the muscles and nerves of the esophagus have difficulty co-ordinating themselves. This makes it more difficult for food and liquids to move towards the stomach.
  • Sometimes food and liquid can collect in the esophagus at the site of the surgery. This can stretch the upper portion of the esophagus.
  • Scar tissue at the surgical site may tighten. This can make the esophagus stricture (become narrower), causing solid food to get stuck.

How to help your child eat after EA/TEF repair

Bottle or breastfeeding

  • Your child may experience difficulties drinking liquids and may need to be assessed by an occupational therapist (OT) while in the hospital.
  • If your child is struggling to swallow their feeds, their esophagus may have narrowed. Contact your healthcare provider.

Introducing solid food to babies

  • Pureed fo​od​ is usually introduced to a child between four and six months of age. This will likely be the case for your child as well. Check with your healthcare provider before starting your child on purees.
  • Once your child is able to take smooth purees, feel free to try thicker, more solid textures. First make sure that your child is able to hold their head up and sit comfortably (with some support) in a highchair.

Offering solids to toddlers and older children

  • As your child’s diet progresses, avoid food that is sticky or gooey or food that becomes sticky or gooey after chewing, such as soft bread. This type of food can be hard to swallow because it becomes a sticky ball when it is chewed.
  • Be aware that some children gag and refuse solids or lumpy food. If this is your child’s experience, ask your child’s occupational therapist (OT) for tips to help move from one food texture to another.
  • If you are offering table food, make sure it is cut into small pieces and that your child chews it really well. Very hard food, or food that is not chewed well, can be difficult to swallow and may get stuck.
  • Serve foods with lots of liquids (such as dressings, dips, sauces and gravies) to help with swallowing.
  • Some finger and table food can help to keep scar tissue stretched, but children may tolerate some textures more than others.

Mealtimes

Mealtimes should be similar to those for any child.

  • Provide a balanced diet that includes all food groups from Canada’s Food Guide: vegetables and fruit, grain products, milk and alternatives and meat and alternatives.
  • Serve your child several small meals during the day. Many children need to eat five or six small meals throughout the day after esophageal atresia or tracheoesophageal fistula (EA/TEF) repair.
  • Aim for meals every three or four hours.
  • Do not let mealtimes last more than 30 minutes.
  • Encourage your child to:
    • sit upright while eating (highchairs or booster seats can help younger children)
    • take small bites and chew their food well
    • eat slowly.
  • If your child finds it difficult to eat within the time limits of school meal or snack times, talk to your healthcare provider about offering higher calorie drinks (such as smoothies or yogurt drinks).

How to deal with common swallowing problems

Food getting stuck

Sometimes food will get stuck in the esophagus for a short time. In most cases, it will slowly pass through or your child will cough it up.

  • To prevent food from sticking, let your child take a few sips of liquid after every two or three bites.
  • Add more dressings, dips, sauces or gravy to food to help your child swallow it more easily.
  • If food does get stuck, stay calm and offer a few sips of liquid.
  • Suggest that your child sing their favourite song or ask your child simple questions to help stay calm while they wait for the food to go down.
  • If an item remains stuck, contact your healthcare provider.

Inability to eat or drink because of strictures

  • If your child’s esophagus becomes strictured (a narrowing caused by scar tissue), they may not be able to eat or drink. Their esophagus will need to be dilated (stretched). In the meantime, your child’s healthcare team can give you instructions to care for your child.
  • How a stricture affects the movement of food through the esophagus
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    A stricture in the esophagus is a narrowing caused by scar tissue. A stricture can cause food to get stuck.
     
  • If your child can still take liquids by mouth, you will be instructed on how to keep them hydrated.
  • If your child has a feeding tube, you will be instructed to give formula or fluids through the tube.

When to get medical help for swallowing difficulties

Contact your child’s healthcare provider if:

  • your child is struggling to swallow solids, liquids or their own saliva
  • food has gotten stuck and does not pass through with the help of some sips of liquid
  • your child’s eating has changed significantly (only liquids or gagging on or vomiting food) for two meals in a row.

Key points

  • Your child might find it difficult to swallow food and liquids after EA/TEF repair. This is called dysphagia.
  • You can help your child by serving foods with dressings or sauces, letting your child take sips of liquid after every two or three bites, cutting food into small pieces and scheduling five or six small meals during the day.
  • If food becomes stuck, stay calm, offer some sips of liquid and distract your child while they wait for the food to pass.
  • Contact your child’s healthcare provider if your child finds it hard to swallow even their own saliva, if food does not pass with the help of liquid or if their eating habits have changed a lot for two meals in a row.
​​​​
​Beth Haliburton, RD
Ashley Graham, OT
1/26/2015




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