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Silent aspiration prominent in children with dysphagia
1Speech-Language-Hearing and Pediatrics Department, Children's Hospital of Buffalo, NY 14222.
Insights
Children with swallowing difficulties (dysphagia) often silently aspirate liquids, risking lung issues. Modified barium swallow studies (MBS) are vital for diagnosing aspiration in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Speech-Language Pathology
Background:
- Neurologically-based dysphagia poses a high risk of silent aspiration in children.
- Aspiration can lead to serious complications like pneumonia and chronic lung disease.
- Comprehensive swallowing evaluations are critical for managing pediatric dysphagia.
Purpose of the Study:
- To describe the characteristics of aspiration and pharyngeal motility in infants and children.
- To assess the utility of the videofluoroscopic modified barium swallow study (MBS) in evaluating pediatric dysphagia.
- To identify children at risk for aspiration and inform management strategies.
Main Methods:
- Retrospective analysis of 186 infants and children undergoing videofluoroscopic modified barium swallow studies (MBS).
- Assessment of oral, pharyngeal, and upper esophageal phases of swallowing.
- Documentation of aspiration presence, type, and timing relative to the swallow.
Main Results:
- Aspiration was identified in 26% (48/186) of children, predominantly with liquids.
- The majority of aspiration events (94%) were trace and silent.
- MBS effectively delineated pharyngeal and upper esophageal function, often not apparent through clinical assessment alone.
Conclusions:
- Silent aspiration is a significant concern in children with dysphagia.
- The modified barium swallow study (MBS) is crucial for objective assessment of aspiration risk.
- MBS should be considered for all children with severe dysphagia to confirm or rule out aspiration and guide treatment.
Abstract:
Children with neurologically-based dysphagia are at high risk for silent aspiration. Aspiration can lead to complications such as acute pneumonia and chronic lung disease. Thorough evaluation of the oral, pharyngeal, and esophageal phases of swallowing is crucial for patients with dysphagia. The videofluoroscopic modified barium swallow study (MBS) is the procedure of choice for children to delineate the pharyngeal and upper esophageal phases of the swallow that can only be inferred by bedside clinical assessment. This study describes attributes of aspiration and pharyngeal motility in a large sample of infants and children assessed with MBS. Aspiration was observed in 48 (26%) of 186 children, primarily on liquid before or during swallows. Aspiration was trace (less than 10% of a bolus) and silent in 94%. Relationships to clinical history and implications for management are discussed. Given the lack of objective clinical information to identify children at risk for aspiration, MBS should be considered in all children with severe dysphagia to rule out or confirm aspiration.