Pediatric Chronic Aspiration

Pediatric Chronic Aspiration

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Summary

Chronic aspiration describes foreign bodies that are repeatedly inhaled into the lungs.

Expanded overview

Chronic aspiration is when a child repeatedly breathes in any food/drink, saliva, or undigested stomach contents that come back up the esophagus. These materials are known as foreign bodies, and the continual inhalation can cause several chronic (recurring) respiratory issues. It differs from acute (sudden) foreign body aspiration that can occur at irregular intervals.

If left untreated, chronic aspiration can be life threatening. It can also lead to:

  • Sleep apnea  (temporarily stop breathing while sleeping)
  • Persistent wheezing or cough (lasting more than three weeks)
  • Recurrent pneumonia 
  • Lung injury
  • Respiratory disability

Causes

Several conditions can cause chronic aspiration, including:

  • Dysphagia  – This disorder makes swallowing painful or impossible due to the muscles of the pharynx or esophagus not functioning properly.
  • Gastroesophageal reflux disease (GERD)  – This digestive condition causes partially digested food or stomach acids to flow back into the esophagus (tube that connects the throat with the stomach).
  • Neurological disorders – Conditions like cerebral palsy can affect body movement, posture and muscle coordination, which can lead to a greater chance of aspiration.
  • Structural abnormalities – Anatomical irregularities can lead to a higher risk of aspiration. These include:
    • Cleft palate – a gap in the roof of the  mouth
    • Duodenal obstruction – a complete or partial blockage that prevents food from passing out of the stomach
    • Esophageal atresia – a malformation that obstructs the upper esophagus and causes a child to have difficulties with swallowing and eating
    • Laryngeal cleft – a gap between the larynx (voice box) and the esophagus
    • Tracheoesophageal fistula – one or more abnormal connections between the child’s esophagus and trachea (windpipe)

Symptoms

Symptoms will vary according to the cause and severity of the condition responsible for the aspiration. Symptoms can include:

  • A weak suck while breast or bottle feeding
  • Bradycardia (abnormally slow heartbeat)
  • Chest discomfort
  • Choking, coughing or gagging while eating
  • Cyanosis (blue or gray fingertips and lips)
  • Drooling
  • Food becoming stuck or coming back up after eating
  • Hoarse voice or ragged cry
  • Light fever after eating
  • Rapid breathing or holding breath while eating
  • Repeated respiratory infections
  • Sleep apnea
  • Wheezing

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