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Evaluation and Management of Chronic Aspiration in Children With Normal Upper Airway Anatomy

Eelam Adil1, Hasan Al Shemari2, Amy Kacprowicz2

  • 1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.

JAMA Otolaryngology-- Head & Neck Surgery
|October 27, 2015
PubMed

Insights

Pediatric airway aspiration in children with normal anatomy often resolves with feeding and swallowing therapy. Most cases of thin and thickened liquid aspiration improve within a year, with few requiring tracheostomy.

Area of Science:

  • Pediatric Pulmonology
  • Pediatric Gastroenterology
  • Pediatric Otolaryngology

Background:

  • Chronic airway aspiration poses significant challenges in pediatric care, leading to pulmonary morbidity.
  • Understanding the causes and optimal management of pediatric aspiration is crucial.

Purpose of the Study:

  • To review the evaluation and management of pediatric patients diagnosed with aspiration.
  • Focus on patients with normal upper airway anatomy.

Main Methods:

  • Retrospective review of pediatric patients diagnosed with aspiration via modified barium swallow study over 10 years.
  • Included direct laryngoscopy and bronchoscopy under general anesthesia.
  • Analyzed demographics, comorbidities, management, and swallowing outcomes.

Main Results:

  • 46 pediatric patients met inclusion criteria; mean age 1.56 years, 2:1 male to female ratio.
  • Common comorbidities included developmental delay (35%) and congenital heart disease (26%).
  • Feeding and swallowing therapy led to resolution in 84% aspirating thin liquids and 80% aspirating thickened liquids; 7% required tracheostomy.

Conclusions:

  • Feeding and swallowing therapy is recommended for children with normal upper airway anatomy experiencing aspiration.
  • Brain MRI may be indicated for suspected brainstem or posterior fossa lesions.
  • Most pediatric patients aspirating thin and thickened liquids show resolution within one year of therapy.
Abstract

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