Finally, the differential diagnosis includes several systemic conditions that may affect the normal swallowing process In a large case series of pediatric patients who underwent fiberoptic evaluation of swallowing function after presenting with dysphagia, 36% were found to have structural abnormalities of the aerodigestive tract or airway, 26% had neurologic diagnoses, 12% had gastrointestinal disorders, 8% had genetic syndromes, 5% had prematurity, 3% had cardiovascular anomalies, and 2% had metabolic issues In the adult patient, dysphagia most commonly results from a variety of neuromuscular disorders, whereas the pediatric patient more often has swallowing difficulty from congenital, infectious, inflammatory, or obstructive causes ( Table 56.2 ) Dysphagia occurs in 85% of cerebral palsy patients, and is directly related to the severity of their overall neuromuscular impairment In the newborn or infant, swallowing may be disturbed as a result of prematurity, often associated with respiratory and neurologic disabilities Gastroesophageal reflux is common in infants, although in a small percentage of patients, it may persist into childhood with reflux esophagitis Eosinophilic esophagitis has recently been identified as an important cause of dysphagia, particularly in adolescents and young adults with environmental allergies, atopy, and food allergies Ingestion or aspiration of a foreign body must always be considered in an infant or toddler who has either the acute or chronic onset of dysphagia ( Fig 56.1 ) Swallowing dysfunction is a common complication following pediatric head injury In a review of 1,145 pediatric head injury patients, 68% of those with severe injury and 15% of those suffering moderate injury were found to have dysphagia requiring intervention Postoperative dysphagia is also common after laryngotracheal reconstruction surgery or cardiovascular surgery These patients are predisposed to aspiration due to impaired airway protection