What is aspiration in infants and children?

Aspiration is the content like food, saliva or toxic substances, enter the airways and lungs. Aspiration may occur abruptly and cause pneumonia with symptoms like fever and difficulty breathing. However, aspiration may also be recurrent and silent, in which case the symptoms may not be so apparent or observable but can, notwithstanding, lead to a chronic soiling of  the lungs.

Aspiration may occur due to difficulty in swallowing and eating, but it can be caused gastroesophageal reflux disease (when food  travels from the esophagus and stomach back to the larynx). Aspiration may occur during feeding but also between  meals.

Numerous situations may lead to aspiration. For example:

1. Anatomical abnormalities such as cleft palate, esophageal atresia, tracheoesophageal fistula.
2. Diseases of the gastroenterology system such as gastroesophageal reflux disease.
3. Syndromes like CHARGE, Cri du Chat.
4. Neurological diseases such as cerebral palsy, paralysis of the vocal cords, brain injuries.
5. Neuromuscular diseases such as spinal muscular atrophy, myasthenia, Guillain-Barré syndrome.

Symptoms that may occur:

1. Cough, choking or difficulty breathing during feeding
2. Low grade fever
3. Abnormal lung sounds such as crackles
4. Persistent lower respiratory tract infections
5. Chronic wet cough

Diagnosis of aspiration is mainly based on the patient’s history and clinical examination. However, the contribution of tests such as X-rays, chest computed tomography (CT) scan, swallowing test with the help of a speech therapist is often valuable. Treatment of aspiration lies mostly in the management of the underlying problem. In addition, sometimes the speech therapist suggests ways that facilitate swallowing such as proper posture at meals, thickening feeds etc. Medication or surgical treatment for reflux is often recommended. For hypersalivation, that is, the inability to manage saliva, there are also drugs and in some cases Botox is injected into the salivary glands.