A Guide for Teachers and Caregivers

What is Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)? Esophageal Atresia (EA) is a congenital birth defect of the esophagus ("foodpipe") in which the esophagus is in two segments rather than a continuous connection to the stomach. Tracheoesophageal Fistula (TEF) is a birth defect of the esophagus and the trachea ('windpipe'). The esophagus is connected to the trachea in one or more places which makes eating very dangerous because food and saliva have a direct route to the lungs. These birth defects, which occur in one of every 4,500 babies, are present together 85% of the time. They require at least one major surgery for a baby to survive them.

What you should know about a child born with EA/TEF:

1. Children born with EA/TEF have a characteristic "TEF cough" that is caused by a weakness in the trachea. The presence of this TEF cough alone does not indicate that the child is ill.
2. Many of the children have a history of respiratory problems. The child may be more susceptible to respiratory infections.
3. The child will have poor motility of the esophagus. There will be special considerations when the child is eating or drinking.
4. The child may have gastroesophageal (G.E.) reflux which causes stomach contents to flow back into the esophagus.
5. The child may need to take medication during the school day.

Problems that may occur at school:

Some foods pass through a dysfunctional esophagus more easily than others. Occasionally, food may get "stuck" in the esophagus. The child will gag and appear to be choking. Although it looks frightening, the child will probably be able to cough up the lodged food or get it to pass to the stomach with something to drink.

If the child is able to breathe, but cannot dislodge the food, call his parents. Sometimes it needs to be removed by a pediatric surgeon.

If the child is unable to breathe, it is an immediate emergency. Call 911 and take appropriate action for a choking person.

Special considerations for the child while eating or drinking:

1. The child should never be rushed while eating or drinking. Rushing him could lead to a choking episode.
2. The child will need to eat slower than other children since he will need to take smaller bites and chew more thoroughly.
3. The child should always be upright during and after eating. This will help prevent food from accidentally entering the lungs and causing a lung infection.
4. The child may only be able to eat small portions of food at a time (especially if they have been diagnosed with G.E. reflux).
5. The child will need to drink more than the other children to help food pass into his stomach. It would not be wise to limit fluid intake.

It is very important that anyone who is with the child while he's eating is aware of these special considerations and is trained to take appropriate action for a person who is choking.

The degree of difficulties varies in children born with EA/TEF. The parents are the experts on their child. Please talk to them about concerns you may have regarding their child.