Dysphagia and Chronic Pulmonary Aspiration in Children

Abstract

1. James D. Tutor, MD* 1. *Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children’s Hospital, and St. Jude Children’s Research Hospital, Memphis, TN * Abbreviations: FEES: : fiberoptic endoscopic evaluation of swallowing FEESST: : fiberoptic endoscopic evaluation of swallowing with sensory testing GER: : gastroesophageal reflux VFSS: : videofluoroscopic swallow study Dysphagia and the accompanying pulmonary aspiration are frequently unrecognized by pediatricians and caregivers as a cause of chronic respiratory symptoms such as recurrent wheezing, recurrent pneumonias, chronic cough, stridor, and brief resolved unexplained events (formerly known as acute life-threatening events). In addition, clinicians may be unfamiliar with the proper evaluation or treatment of patients with dysphagia and chronic aspiration. After completing this article, readers should be able to: 1. Recognize the signs and symptoms associated with dysphagia and chronic pulmonary aspiration. 2. Know the conditions predisposing to dysphagia and aspiration in children. 3. Understand the tests that should be used to diagnose dysphagia and chronic pulmonary aspiration. 4. Know when and to what subspecialist(s) to refer the patient who has dysphagia and chronic aspiration. 5. Know the methods available to treat dysphagia and chronic aspiration. 6. Know how to recognize and treat aspiration pneumonia in infants and children. “Dysphagia, defined as difficult or improper swallowing of oral solids, liquids, or both, can lead to aspiration, the inhalation of foreign material into the lower airway. This can produce significant respiratory morbidity and mortality in children.” (1) Dysphagia is described as being oropharyngeal when transfer of the food bolus from the mouth to the esophagus is impaired. The striated muscles of the mouth, pharynx, and upper esophageal sphincter are affected in oropharyngeal dysphagia. Esophageal dysphagia occurs if there is difficulty transporting the food bolus down the esophagus to the stomach. (2) Aspiration may occur in children who have problems with dysphagia. Aspiration can be either acute or chronic and recurrent. Aspiration can lead to pulmonary problems such as recurrent wheezing, recurrent pneumonias, and the development of severe impairment of …