Optimising respiratory health in children with neurodevelopmental impairment

Respiratory complications represent a major cause of morbidity and mortality in children with neurodisability. Neurodisability includes those with neurological impairment (cerebral palsy), neuromuscular impairment (muscular dystrophies) and developmental impairment (global developmental impairment, genetic syndromes). Respiratory complications arise from a complex interplay of factors including bulbar dysfunction, impaired airway clearance, recurrent aspiration, respiratory muscle weakness, and progressive chest wall restriction. Children with neurodevelopmental conditions (e.g. cerebral palsy, developmental disorders) are particularly vulnerable, with respiratory disease accounting for a substantial proportion of hospital admissions and premature deaths. This review provides an overview of the pathophysiological mechanisms underlying respiratory dysfunction in children with neurodevelopmental conditions, outlines assessment strategies, and evaluates current interventions aimed at optimising respiratory health. Key management approaches include airway clearance techniques, secretion management and nutritional optimisation. A multidisciplinary approach incorporating regular surveillance, prevention strategies, and individualised care planning is essential. Despite growing clinical experience, randomised controlled trials remain limited, and significant research gaps persist.