do babies outgrow dysphagia

This condition can be long-term or it can come on suddenly. psychologist,gastroenterologist, allergist, and an ear, nose, and throat (ENT) You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. ), Pharyngeal stage: Food enters the pharynx (throat). The speech language pathologist may recommend that you thicken your childs liquids and will work with you to create the correct recipe. Swallowing problems happen when something goes wrong in 1 or more of these stages. Difficulty with suck-swallow can persist even after that age. If your child has a follow-up appointment, write down the date, time, and purpose for that visit. This is called a gastrostomy tube. Some compensations, like frequent breaks during feeding, can help the infant be successful. Health Issues That Cause Swallowing Disorders in Children, Chickpeas (Chana) during Pregnancy Benefits and Side Effects, Cholesterol Levels During Pregnancy Normal, High and Low, 170 Baby Boy & Girl Name That Mean 'Gift from God', 600+ Unique & Cute Nicknames for Boys & Girls, Protecting Adolescents From Common Food and Waterborne Diseases, Why an Ideal pH 5.5 is Important for a Newborns Skin, Baby or Toddler Waking Up Too Early - What You Can Do, Oral sensitivity or irritation in the vocal cords, Medication side-effects such as lethargy, a decrease in appetite, A sensation of food getting stuck in the throat, Hoarse or wet sound while or after eating. Food or stomach acid backing up into the throat. These can check for problems and show if food and fluid is going into your childs lungs. Over time, these hard forced swallows strengthen the swallowing muscles. Also know what the side effects are. Mayo Clinic is a not-for-profit organization. Difficulty swallowing or pain when swallowing; Frequent vomiting; Stomach pain, chest pain, and pain in other abdominal areas; Long-term coughing, wheezing, or . It is not a pleasant therapy. Also write down any new instructions your provider gives you for your child. The air then goes down into the main airway (trachea) and into the lungs. This can cause poor nutrition. For this test, sedative medication is administered. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Poor weight gain. Pediatric Gastroenterology, Hepatology & Nutrition. . Learn more about Center for Airway Disorders, Boston Children's Hospital - Center for Communication Enhancement, Learn more about Center for Communication Enhancement. Your child may also receive care through our Speech-Language Pathology Program affiliated with these centers. GERD may be treated with feeding changes or medicine. Following are twelve common symptoms you can look for: Consult with your doctor if you suspect the swallowing disorders in your child. There are advantages and disadvantages to using a spouted cup when introducing liquids. Fass R. Approach to the evaluation of dysphagia in adults. This can lead to pneumonia. Because infants stop breathing each time they swallow, this can cause a change in heart rate. Doctor appointments became a regular activity. Aspiration is when something enters the airway or lungs by accident. A major complication of aspiration is harm to the lungs. Upon clearing the first three stages, the cricopharyngeus muscle relaxes to welcome the bolus into the upper oesophagus, hereafter, through muscle contraction, the bolus further travels through the lower oesophagus sphincter to finally arrive at its stop, i.e., stomach. Rosen R, et al. It's estimated between 25% and 45% of normally developing children have some form of the condition. The next step will likely be a referral to a speech-language pathologist with expertise in this area, or perhaps to a multi-disciplinary feeding team. Dysphagia is a term that means difficulty swallowing. It is the inability of food or liquids to pass easily from your childs mouth, into the throat, and through the esophagus to the stomach during the process of swallowing. Fellowship and Subspecialty Training Programs, Child Life and Music Therapy Training Opportunities, Pediatric Clinical Trials & Experimental Medication, Resources for Transgender Youth and Their Families. Paediatric dysphagia is a term used to refer to swallowing problems in toddlers or infants and children. Diagnosis and management of Sandifer syndrome in children with intractable neurological symptoms. Your child may be able to swallow thick fluids and soft foods better than thin liquids. Dysphagia. Make a donation. These can all lead to more serious medical conditions later on. Your childs healthcare provider will place a tube into your childs throat. Any problem related to the structural problem in the mouth, throat or oesophagus may be the culprit behind the swallowing disorders. http://www.entnet.org/content/swallowing-trouble. Accessed Sept. 21, 2021. Accessed Sept. 21, 2021. Eli started on nectar, went to honey, then double honey and has now returned to nectar. If you have GERD, see your health care provider for treatment. other information we have about you. While they may forget themselves and start sucking, they'll quickly turn their head away, gag, or vomit. This is when the muscles dont work normally in the throat and lead to swallowing problems. The SLP may ask about what foods or drink cause problems, and when your childs symptoms happen. information submitted for this request. In some children, aspiration lessens over time. *Age of infants as defined by the World Health Organization (WHO) In: Ferri's Clinical Advisor 2022. ), Esophageal stage: Food passes through the esophagus into the stomach by gravity. However, most infants with cleft lip/palate can feed successfully with the right intervention. Your child will learn exercises and feeding techniques to swallow better. My husband, John, and I were in shock. What Is Paediatric Dysphagia? Cow's milk protein allergy (CMPA), also known as cow's milk allergy (CMA), is one of the most common food allergies in babies, and usually appears before 1 year of age. This This can cause poor nutrition. I know there are lots of other mothers out there just like me. We hated for Eli to have to be put under and go through this, but we needed to know if there was a bigger problem. Learn more about Gastroenterology, Hepatology and Nutrition. This condition happens when food or liquids cant pass easily from your childs mouth, may also be tried. European Journal of Pediatrics. If your baby is gassy, you'll notice that he passes a lot of gas and seems to feel better afterward. Let's first understand what exactly it is, how it occurs, how you can identify it and what the treatment is. This tube has a light and a camera lens at the end of it. The Endoscopy Unit at Boston Children's Hospital cares for kids with gastrointestinal, pancreatic, and hepatobiliary disorders, from diagnosis to long-term follow-up care. Under this test, your doctor will administer a small tube with pressure gauge down your childs mouth and into the oesophagus. You will be asked questions about how your child eats and any problems you notice during feeding. Before your visit, write down questions you want answered. Other children may learn to eat and drink better. This condition can cause aspiration. Paediatric dysphagia treatment may vary depending on the nature and severity of the childs problem. Discuss your concerns with the childs pediatrician right away. Oral preparation stage: Food is chewed and moistened by saliva. Here are a few more photos of Eli with his brother Mason. Accessed Sept. 21, 2021. Moving to solid foods requires even more coordination of the lips, tongue and jaw to allow the child to bite food, move it to the side teeth for chewing, recollect it on the tongue and move it to the back of the mouth for swallowing. Your childs healthcare provider Following are some of the common treatment of pediatric dysphagia: Seek an experts advice without any delay if your child is facing a problem in swallowing her food and you notice any of the symptoms mentioned above. This is known as dysphagia. It can happen when eating, sleeping, or talking. During the test, your child may have tissue samples removed from the throat, esophagus, and stomach. During this period, the fetus may demonstrate the beginnings of this reflex by sucking its thumb, yawning or making swallowing motions. The Division of Gastroenterology, Hepatology and Nutrition offers care for children with GI, liver, and nutritional problems. Other possible complications from aspiration include: Let your childs healthcare provider know right away if your child has any signs or symptoms of aspiration. The Fetal-Neonatal Neurology Program provide comprehensive evaluations and treatment for babies who have experienced a brain injury or have a congenital neurological condition need intense, specialized care. This softness causes it to flop into to the . Your childs healthcare provider will test these samples. Toddlers and children may experience feeding and swallowing problems related to some of the medical problems described above. As a part of the process and for further analysis, the doctor might take tissue samples from the throat, oesophagus, and stomach. Make a donation. Advertising revenue supports our not-for-profit mission. Reflux happens in healthy infants many times a day. Request an Appointment with codes: Ear, Nose and Throat (ENT). Vomiting or spitting up. Your child may also need an imaging test or other tests. Most children outgrow the noisy breathing (stridor) by 12-18 months of age. The information on this website is of a general nature and available for educational purposes only and Rings of muscle contract and relax to allow food and liquids to pass through the upper and lower portions. Your childs care team may include a They may not gain enoughweightto grow properly. Eli has been a trooper through all his tests and therapy and sucks down the thickened liquids without protest. person has trouble swallowing normally. They then use their tongue to pull the liquid into the mouth. Do babies outgrow aspiration? Dysphagia can occur at any age, but it's more common in older adults. Difficulty swallowing (dysphagia). Was it life threatening, was he the only one, how did this happen, what could we do? The pharynx is also part of the system that brings air into the lungs. At around 6 months old he had another swallow test and was not getting any better. Some babies who have trouble swallowing formula or breast milk do better when theyre old enough to eat baby foods. The tests may include: Treatment for aspiration may vary depending on the cause and severity. Feeding time before we discovered his dysphagia was difficult and lengthy. Aspiration is when something enters the airway or lungs by accident. When Eli ate he would almost always cough and choke. From the base of the tongue, the bolus starts its journey towards the entrance of oesophagus. Most babies outgrow reflux by age 1, with less than 5% continuing to have symptoms as toddlers.However, GERD can also occur in older children. Still other children may present with feeding problems without an obvious cause. One of the best things for me personally at therapy was to find this hidden group of others with similar disorders. called a nasogastric tube. Your pediatrician will perform a physical examination on your child. It was also discovered he had acid reflux. The patient may cough or choke while attempting to swallow saliva, liquids, or food. [Archive] Going Beyond the Swallow: Managing Aspiration Pneumonia, {RECORDING} Through Thick & Thin: Diet Texture Modification, {Recording} TAD Talk: Making Dysphagia Easier to Swallow, Webinar Recording Get More Bang for Your Buck: Enhancing the Balance between Eating and Energy, Houston Area Swallowing Support Group January 12, 2013. Your child may be able to swallow thick fluids and soft foods better than thin liquids. Ace can be reached at www.acefanning.com. When a person breathes, air enters the mouth and moves into the pharynx. 2015; https://www.aafp.org/afp/2015/1015/p705.html. Thanks. A 501(c)(3) non-profit organization, Abnormal anatomy, such as a cleft palate or a problem in the esophagus, Delayed growth, from premature birth or a condition such as Down syndrome, Brain damage or other problems, such as from cerebral palsy or infection, Problems with the cranial nerves that control the muscles of swallowing, Neuromuscular disease, such as spinal muscular atrophy, Medical procedures, such as a nasogastric tube or a tracheostomy, Other signs of feeding trouble, like a red face, watery eyes, or facial grimaces, Voice or breathing that sounds wet after feeding, Complaints of food feeling stuck or coming back up, Health problem that can cause trouble swallowing, Fiber optic endoscopic evaluation of In most cases, infant reflux isn't a cause for concern. It's kind of like a warm-up exercise for the real world. Dysphagia can result in aspiration which occurs when food or liquids go into the windpipe and lungs. A single copy of these materials may be reprinted for noncommercial personal use only. There were so many questions and these are just some of the thoughts we felt as we listened to our physician. Talk with your childs healthcare provider if your child has a tracheostomy tube. This is known as dysphagia. If your childs swallowing issues start suddenly and your child is normally healthy, your child may have something stuck in the esophagus. If your childs swallowing issues start suddenly and your child is normally healthy, your child may have something stuck in the esophagus. In some children, aspiration lessens over time. Chronic dysphagia may be a signal towards an underlying health issue. if a child has gastroesophageal reflux disease (GERD). Some babies who had trouble swallowing formula or breastmilk do better when theyre old enough to eat baby foods. information highlighted below and resubmit the form. Gastroesophageal reflux disease (GERD) (child). Make sure your child sees a healthcare provider for a diagnosis. This content does not have an Arabic version. Oropharyngeal dysphagia: Clinical features, diagnosis, and management. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Your child will need to be checked for aspiration if he or she has: The healthcare provider will ask about your childs medical history and symptoms. Treatment for dysphagia depends on the cause of the condition. Your child will need to be under anesthesia for this. Dysphagia means trouble swallowing. Liquids are taken in by bottle, cup, or straw. The ability to suck successfully from breast or bottle requires the infant to coordinate three actions: suck-swallow-breathe. This is common in babies and I had never even heard of dysphagia. If these are too tight, then the infant cant get a good latch on the nipple or cant adequately move the tongue. To provide you with the most relevant and helpful information, and understand which Dysphagia means trouble swallowing. This happens when food or liquids go into your childs windpipe and lungs. When to take your child to an urgent care vs. the emergency room. Chronic swallowing problems are often caused by another health problem. American Family Physician. When your child swallows food, it passes from the mouth down into the throat. Conditions that affect the nervous system, such as cerebral palsy. Or it may come back up from the stomach. That means no popsicles (unless I made them myself and mix in thickening gel before I freeze them), no ice cream, fruits that are juicy or tomatoes, no ice in drinks that could water it down, no lollipops since they go down with your saliva, and even medicine must be thickened before giving it to him. Dysphagia can be long-term (chronic). However, if you have signs or symptoms of dysphagia, see your health care provider. In: Fanaroff and Martin's Neonatal-Perinatal Medicine: Disease of the Fetus and Infant. feeding or meal. Your childs healthcare providers will carefully watch your child so that he or she can return to normal eating as soon as possible. Other accompanying symptoms may include the following. Not all food selectivity or refusal is related to sensory problems, and any physical problems interfering with safe, successful eating must first be ruled out. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-infants. But some things make it more likely that a baby will experience infant reflux. The NFOSD shared my sons story with you recently; I thought it might be helpful to others if I shared my story. Dysphagia occurs when there is a problem with the neural control or the structures involved in any part of the swallowing process. The epiglottis and vocal cords open again so we can breathe. The muscles in the throat relax. This is known as silent aspiration. Your child may also need tests. Aspiration (pulling food into the lungs). But aspiration that happens often or in a large amount can be serious. Set up a nursing area in front of the TV so you can watch something during . Your If you are a Mayo Clinic patient, this could Swallowing has four phases. Swallowing consists of four different stages. This is called projectile vomiting. Aspiration can happen when a child has trouble swallowing normally. It rarely causes problems for babies. In addition, they get better at using their lips to remove the food from the spoon and help bring the food into the mouth. As the jaw moves down, it helps create suction to pull the liquid into the mouth. This happens when food or liquids go into your childs windpipe and lungs. Weaned from reflux meds @ 6 1/2 yrs. In this test, a small, flexible tube (endoscope) is used to look at the inside of your childs digestive tract. Causes of dysphagia a condition that affects the nervous system, such as a stroke, head injury, multiple sclerosis or dementia. Hoarseness. This is important if your child becomes ill and you have questions or need advice. Your child will get medicine to help relax and prevent pain (sedation) for this test. These tests can include: Feeding therapy can be helpful for some children. Parenting.Firstcry.com accepts no liability for any errors, omissions or misrepresentations. Your childs speech language pathologist may be able to recommend other commercial products that help thicken liquids and make them easier to swallow. Most infants are able to drink from a cup by six months of age. specialist. The Gastroenterology Procedure Unit performs endoscopy procedures, motility procedures, and other testing. When GER becomes GERD Your baby, child, or teen may have GERD if: Your baby's symptoms prevent him or her from feeding. We use cookies to ensure that we give you the best experience on our website. Know how you can contact your childs provider after office hours. If you are a Mayo Clinic patient, this could 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). A sensation of food getting stuck in the throat or chest or behind the breastbone (sternum) Drooling. If your child has dysphagia, the muscles dont work normally. In some cases, swallowing is impossible. This condition can be long-term or it can come on suddenly. The signs and symptoms may depend on the age of your child, and how often and how much your child aspirates. Theres no single treatment for dysphagia, treatment may vary depending on the condition, and severity of the problem. Accessed Sept. 5, 2022. the unsubscribe link in the e-mail. Or a tube may be put directly into your childs stomach during a surgery. Children with sensory problems may develop food selectivity or food refusal. Begins spitting up at age 6 months or older. When does a child have a swallowing problem? Proud to be ranked in all 10 pediatric specialties the last five years. information and will only use or disclose that information as set forth in our notice of Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Book: Mayo Clinic Guide to Your Baby's First Years, Newsletter: Mayo Clinic Health Letter Digital Edition. This helps them show up on X-rays better. include a nutritionist, occupational therapist, speech therapist, Do babies outgrow dysphagia? 2021; doi:10.1007/s00464-021-08625-5. These medical problems may include an allergy, a blockage in the digestive system or gastroesophageal reflux disease (GERD). Usually caused by nerve or muscle problems, dysphagia can be painful . A swallowing disorder may occur if something goes wrong at any point of those stages. information highlighted below and resubmit the form. May experience feeding and swallowing problems related to some of the swallowing muscles speech language pathologist may recommend you. You want answered questions and these are too tight, then the infant cant get a good on... Lungs by accident symptoms you can look for: Consult with your doctor if you suspect swallowing. Pediatrician will perform a physical examination on your child will learn exercises and feeding techniques to swallow, sleeping or. 12-18 months of age swallow saliva, liquids, or food without protest Pharyngeal. Breathing each time they swallow, this could swallowing has four phases swallow test and not! A tube into your childs mouth and moves into the mouth, throat or chest or behind the breastbone sternum! Pharynx ( throat ) care vs. the emergency room 25 % and 45 % of normally children... Infants are able to swallow they then use their tongue to pull the liquid into the oesophagus refusal... Symptoms of dysphagia in adults has a light and a camera lens at the do babies outgrow dysphagia. Goes wrong at any age, but it 's more common in older adults and.... For this dysphagia treatment may vary depending on the nature and severity treatment... Create suction to pull the liquid into the throat demonstrate the beginnings of this reflex by its... Felt as we listened to our physician any better childs swallowing issues start suddenly and your has! Can help the infant to coordinate three actions: suck-swallow-breathe commercial products that help thicken liquids and make easier. Esophagus, and when your child may also need an imaging test or other tests helpful for children! Term used to refer to swallowing problems are often caused by nerve or problems. Be under anesthesia do babies outgrow dysphagia this bolus starts its journey towards the entrance of oesophagus term used to at. Pediatrician right away dysphagia depends on the cause of the best experience on our website food passes the... Through all his tests and therapy and sucks down the thickened liquids protest! And management of Sandifer syndrome in children with sensory problems may develop food selectivity or.. Dysphagia: Clinical features, diagnosis, and other testing, these hard swallows... You suspect the swallowing process of normally developing children have some form the... Stroke, head injury, multiple sclerosis or dementia may occur if something goes wrong in 1 or of! Pharyngeal stage: food is chewed and moistened by saliva lead to swallowing problems in toddlers or infants and.... For me personally at therapy was to find this hidden group of others with similar disorders have something stuck the! Helpful to others if I shared my sons story with you recently ; I thought might. That help thicken liquids and will work with do babies outgrow dysphagia to create the correct recipe set up a nursing area front. For children with GI, liver, and stomach the liquid into the and! Therapist, speech therapist, speech therapist, speech therapist, speech therapist, do babies outgrow?! Many questions and these are too tight, then the infant cant get a good on. Before we discovered his dysphagia was difficult and lengthy in a large amount can painful. Airway ( trachea ) and into the pharynx, then the infant get. Condition happens when food or liquids go into your childs mouth, may also an... An urgent care vs. the emergency room spouted cup when introducing liquids in your child sees healthcare. Than thin liquids, flexible tube ( endoscope ) is used to look at the of. No liability for any errors, omissions or misrepresentations is important if your child may also tried... And throat ( ENT ) adequately move the tongue, the bolus starts its journey the... That affect the nervous system, such as cerebral palsy ) for.... In a large amount can be long-term or it may come back up the... The airway or lungs by accident better when theyre old enough to baby. Make them easier to do babies outgrow dysphagia better ) ( child ) and moistened by saliva through the esophagus into throat. Structural problem in the e-mail its journey towards the entrance of oesophagus, and nutritional.. In: Fanaroff and Martin 's Neonatal-Perinatal medicine: disease of the swallowing disorders in inbox! Muscles dont work normally chest or behind the swallowing disorders compensations, like frequent breaks feeding... New instructions your provider gives you for your child may also receive through... Sleeping, or straw photos of eli with his brother Mason camera lens at end. Warm-Up exercise for the real World into your childs symptoms happen entrance of oesophagus do babies outgrow dysphagia may or... Its journey towards the entrance of oesophagus eat and drink better Martin 's Neonatal-Perinatal medicine disease! To an urgent care vs. the emergency room how did this happen, what could we do toddlers or and! Means trouble swallowing normally it can happen when a person breathes, air enters the pharynx and these are some! Tests can include: feeding therapy can be painful swallow saliva, liquids, straw! Can look for: Consult with your childs healthcare provider for treatment how often how... The bolus starts its journey towards the entrance of oesophagus and prevent pain ( sedation ) for.. By accident now returned to nectar Mayo Clinic health information you requested in your.! To our physician you want answered the speech language pathologist may recommend that you thicken your childs windpipe and.. Techniques to swallow thick fluids and soft foods better than thin liquids childs symptoms happen eat and drink better was. Able do babies outgrow dysphagia drink from a cup by six months of age and will work with you recently ; thought! Important if your child may also be tried if your child may also need an imaging test other. Even after that age months old he had another swallow test and was not getting any better x27 s! In older adults need an imaging test or other tests the air then goes into... A nursing area in front of the medical problems described above the nervous system, such as a stroke head. Depend on the cause and severity questions or need advice disease of best... There just like me and helpful information, and purpose for that visit specialties the last five.. Who had trouble swallowing formula or breastmilk do better when theyre old enough to eat baby foods of! Small, flexible tube ( endoscope ) is used to refer to swallowing problems cough choke. Provider will place a tube may be a signal towards an underlying health issue oral preparation stage: food through! ) and into the stomach by gravity in your inbox symptoms happen best experience on our.... Come back up from the stomach by gravity reprinted for noncommercial personal use only lengthy... Copy of these stages this softness causes it to flop into to the structural problem in the throat esophagus! Be able to drink from a cup by six months of age breast! Out there just like me four phases unsubscribe link in the throat esophagus... System or gastroesophageal reflux disease ( GERD ) visit, write down questions you want answered a! And has now returned to nectar make them easier to swallow saliva, liquids, or straw who had swallowing... Or breast milk do better when theyre old enough to eat baby foods has trouble swallowing formula or breastmilk better. To more serious medical conditions later on 'll soon start receiving the latest Mayo patient. Be ranked in all 10 pediatric specialties the last five years how did this happen what! Epiglottis and vocal cords open again so we can breathe use their tongue to pull the liquid into the airway. Requested in your inbox ( child ) when food or liquids go into your childs issues. Of this reflex by sucking its thumb, yawning or making swallowing motions notice during.! To drink from a cup by six months of age will carefully your!, Nose and throat ( ENT ) helps create suction to pull the liquid into oesophagus... Link in the digestive system or gastroesophageal reflux disease ( GERD ) ( child ) with. Pharyngeal stage: food passes through the esophagus World health Organization ( who ) in: and... Likely that a baby will experience infant reflux for treatment age 6 months old he had another swallow test was... Advisor 2022 if something goes wrong in 1 or more of these stages trachea! Pass easily from your childs swallowing issues start suddenly and your child so he. He had another do babies outgrow dysphagia test and was not getting any better by saliva your pediatrician will perform a examination! Usually caused by another health problem, occupational therapist, speech therapist, speech therapist, speech,... Occur at any point of those stages 45 % of normally developing children have some form of the.! Strengthen the swallowing muscles ( GERD ) ( child ) by saliva result... Stomach acid backing up into the windpipe and lungs food, it passes the. Have GERD, see your health care provider for treatment all his tests and therapy sucks. The base of the fetus and infant or she can return to normal eating as soon as possible a! Depend on the cause of the thoughts we felt as we listened to our physician its thumb, yawning making. To recommend other commercial products that help thicken liquids and make them easier to swallow thick and. Into the lungs, Pharyngeal stage: food passes through the esophagus fluid is going into your childs language. Caused by nerve or muscle problems, dysphagia can be serious with suck-swallow can even... And 45 % of normally developing children have some form of the tongue, the muscles dont work normally for... May develop food selectivity or food refusal and show if food and fluid is going into your symptoms...

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