Aspiration in Children

Your child may aspirate when problems with swallowing causes liquids or food to enter your child’s lungs.

If your child aspirates, they may present with a cough when drinking or eating. Aspiration can cause symptoms including:

• Coughing when drinking, particularly with thin liquids
• Difficulty feeding
• Frequent respiratory infections or recurrent pneumonia
• Noisy breathing while drinking
• Gagging during meals
• Back arching during feeding
• Skin turning a bluish color
• Redness around the eyes during or after feeding
• Vomiting during feeding
• Rattling in the throat or chest
• Poor growth

Many factors can lead to aspiration. These include:

• Oropharyngeal discoordination occurs when your child has difficulty swallowing because of problems with their mouth, tongue, palate, larynx, or the muscle at the top of the esophagus. This is mainly due to immaturity and developmental issues. Children who are born premature or who have had surgery on the heart, lungs, or chest may also have a higher risk for the condition.
• Anatomic issues can result in food or drink going into the lungs. Examples of these include laryngeal cleft, laryngomalacia, vocal cord paralysis, esophageal atresia, and tracheoesophageal fistulas.
• Neurologic conditions that impair the oropharynx and esophagus can cause aspiration. Neurologic causes for aspiration may include children with infantile spasms, cerebral palsy, or certain genetic syndromes. 

If your child’s doctor or speech-language pathologist suspects the aspiration, they should perform a physical examination and one or more tests to evaluate swallowing, including:

• Physical examination, including a complete head and neck examination, to be sure there is no anatomical issues contributing to aspiration
• Flexible laryngoscopy in the office to evaluate the upper airway and larynx (voice box) for possible anatomical issues
  • A flexible camera is passed through your child’s nose and used to evaluate the upper airway anatomy and status of the vocal cords.
• Clinical feeding evaluation (CFE) with a speech-language pathologist who specializes in pediatric feeding and swallowing disorders
  • An office visit during which your child eats or drinks and the speech-language pathologist assesses their oral motor coordination, sensory responses, and developmental feeding skills. The SLP also screens for aspiration.
• Videofluoroscopic swallow study (VFSS), also known as a modified barium swallow study (MBS)
  • Your child is given small amounts of a liquid or solid that contains barium (a chalky liquid that will show up on an X-ray). They are seated upright or in the position that you feed them in at home. A series of moving picture X-rays are taken to evaluate what happens as your child swallows the food or drink
• Fiberoptic endoscopic evaluation of swallowing (FEES) exam: A flexible camera is passed through your child’s nose and is used to see parts of the throat. Your child will eat and drink with the scope in place, and the speech-language pathologist and otolaryngologist will assess for aspiration.
• Esophageal manometry: In this procedure a small flexible tube is placed into the nose and passed into the esophagus. It can determine how well your child’s esophagus is working by measuring the pressure and coordination of the esophageal muscles.

The skilled clinicians in the Center for Airway Disorders, Aerodigestive Center, and Feeding and Swallowing Program are experienced in diagnosing and treating children who aspirate. We have a rich understanding of the complexity of the swallowing process, which allows us to consider all aspects of this condition when evaluating and treating aspiration and its causes.

Through this multidisciplinary approach, providers in the Otolaryngology, Gastroenterology, and Pulmonology Divisions collaborate to provide a comprehensive approach for the treatment of your child. Your child’s doctor and/or speech-language pathologist may suggest you change the way you feed your child to decrease the risk that food/liquid will enter their lungs. For example, you may need to use a different bottle nipple or cup, add thickener to their liquids, or feed them in a different position. In rare cases, they may need to receive liquids by a tube through their nose or stomach if a safe feeding plan cannot be identified.

The team will work closely to support you and your family throughout the process and to determine the appropriate timeframe for follow-up. This often includes repeat testing, gradual changes to the diet plan, and/or feeding therapy techniques. Our goal is to provide both medical management and the best minimally invasive surgical approach, if needed, to resolve the underlying cause of the aspiration.