Conditioned dysphagia in cleft palate children after pharyngeal flap surgery.

A nonorganic pattern of maladaptive eating behavior was identified and diagnosed as conditioned dysphagia in a group of 28 children who had successfully completed pharyngeal flap surgery for correction of hypernasality. The physically intrusive diagnostic and surgical procedures are thought to contribute to the acquisition of a conditioned avoidance response to deglutition that is resistant to extinction but reversible after deconditioning therapy. Comparison with 22 matched normal siblings and 25 normal control children identified conditioned dysphagia as occurring in about 40% of the cleft palate children within 1 year after surgery. Characteristic eating problems included slowness, requiring assistance, eating only small pieces of solid foods, and not finishing meals. Early detection, treatment, and preventive measures are suggested at or about the time of surgery to avoid consequent nutritional deficits and, in some severe cases, a threat to survival if untreated.