Aspiration due to swallowing dysfunction in infants and children
- Paul C Stillwell, MD
Paul C Stillwell, MD
- Senior Instructor, Department of Pediatrics
- University of Colorado Anschutz Medical Campus
- Breathing Institute Children’s Hospital Colorado
- Emily M DeBoer, MD
Emily M DeBoer, MD
- Assistant Professor, Department of Pediatrics
- University of Colorado Anschutz Medical Campus
- Breathing Institute Children’s Hospital Colorado
Aspiration is defined as the entry of foreign material into the airway below the true vocal cords. Some aspiration occurs in normal individuals, especially when the airway protective mechanisms are stressed, such as while talking, laughing, eating, or sleeping . In most instances, an inconsequential amount of material is aspirated. In contrast, children with swallowing dysfunction are at risk for pathologic aspiration. The amount of aspiration that is harmful likely varies for different children. Pathologic aspiration may result in acute or chronic pulmonary disease, and impaired nutritional intake may lead to failure to thrive.
Swallowing dysfunction leading to aspiration presents major therapeutic challenges that often require the efforts of a coordinated multidisciplinary team consisting of the patient’s primary caregiver, health care providers with expertise in swallowing (speech and occupational therapists), and selected pediatric subspecialists (pulmonologist, gastroenterologist, otolaryngologist, neurologist, and developmental pediatricians). Aerodigestive programs specializing in patients with swallowing problems are becoming more common at large pediatric centers.
DEVELOPMENT OF FEEDING AND SWALLOWING
The process of swallowing matures during infancy, beginning with suckling movements in utero and progressing to the development of chewing during early childhood [2,3]. Recognition of these developmental states informs the evaluation of swallowing disorders.
●Suckling, the earliest form of sucking, begins in utero with suckling and swallowing of amniotic fluid. It is characterized by a primitive anterior to posterior movement of the tongue. In premature infants, disordered patterns of suckling with bursts and pauses can persist through 32 to 34 weeks gestational age . After this time, sucking becomes more rhythmic and organized. (See "Sucking and swallowing disorders in the newborn".)
●At three to four months of age, lateral tongue movements allow some bolus formation. By six months, children can eat pureed foods from a spoon.
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- DEVELOPMENT OF FEEDING AND SWALLOWING
- CAUSES OF SWALLOWING DYSFUNCTION
- Anatomic abnormalities
- Functional disorders
- CLINICAL PRESENTATION
- Clinical assessment of feeding
- Available diagnostic techniques
- - Videofluoroscopic swallow study
- - Fiberoptic endoscopic examination of swallowing
- - Gastroesophageal scintigraphy and salivagram
- - Potential biomarkers of aspiration
- Lipid-laden macrophages
- Other biomarkers
- Additional evaluation
- Feeding decisions
- Techniques to enhance oral feeding
- Gastrostomy feeds
- Management of salivary aspiration
- Management of gastroesophageal reflux
- - Fundoplication
- - Jejunal feeds
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS