Pediatric Aspiration

Aspiration is when something enters the airway or lungs by accident. It may be food, liquid, or some other material. This can cause serious health problems, such as pneumonia. Aspiration can happen when a person has trouble swallowing normally. This is known as dysphagia. It can also happen if a child has gastroesophageal reflux disease (GERD). This is when the contents of the stomach come back up into the throat.

When your child swallows food, it passes from the mouth down into the throat. This is called the pharynx. From there, the food moves down through a long tube (esophagus) and into the stomach. This journey is made possible by a series of actions from the muscles in these areas. If your child has dysphagia, the muscles don’t work normally. They cause problems with the swallowing process.

The pharynx is also part of the system that brings air into the lungs. When a person breathes, air enters the mouth and moves into the pharynx. The air then goes down into the main airway (trachea) and into the lungs. A flap of tissue called the epiglottis sits over the top of the trachea. This flap blocks food and drink from going down into the trachea when your child swallows. But in some cases, food or drink can enter the trachea. It may go down as your child swallows. Or it may come back up from the stomach. A child with dysphagia is much more likely to aspirate. A child with a developmental or health problem is more likely to have dysphagia.

Aspiration can happen during a feeding or meal. And it can happen after a feeding or meal. This is common in babies and children with certain health conditions. Aspiration can also happen at any time when your child swallows saliva.

If your child aspirates a small amount of material, it may not cause much harm. This can happen in children who don’t have a health problem. It can happen when eating, sleeping or talking. But aspiration that happens often or in a large amount can be serious.

Aspiration is often caused by dysphagia. This is when the muscles don’t work normally in the throat and lead to swallowing problems. Different medical conditions can lead to this, such as:

• Abnormal anatomy, such as a cleft palate or a problem in the esophagus
• Delayed growth, from premature birth or a condition such as Down syndrome 
• Brain damage or other problems, such as from cerebral palsy or infection
• Problems with the cranial nerves that control the muscles of swallowing
• Neuromuscular disease, such as spinal muscular atrophy 
• Medical procedures, such as a nasogastric tube or a tracheostomy

Gastroesophageal reflux disease (GERD) can also cause aspiration. This is when the contents of the stomach come back up into the throat.

Aspiration can cause signs and symptoms in a baby such as:

• Weak sucking
• Choking or coughing while feeding
• Other signs of feeding trouble, like a red face, watery eyes or facial grimaces
• Stopping breathing while feeding
• Faster breathing while feeding
• Voice or breathing that sounds wet after feeding
• Slight fever after feedings
• Wheezing and other breathing problems
• Repeated lung or airway infections

Aspiration can cause signs and symptoms in an older child such as:

• Choking or coughing while eating
• Voice that sounds wet after eating
• Slight fever after meals
• Complaints of food feeling stuck or coming back up
• Wheezing and other breathing problems
• Repeated lung or airway infections

Signs and symptoms can happen right after eating. Or they may happen over time. Your child may not have all of these signs and symptoms. The signs and symptoms may depend on the age of your child, and how often and how much your child aspirates.

Some children who aspirate do not have any signs or symptoms. This is called silent aspiration.

Your child will need to be checked for aspiration if he or she has:

• Any signs or symptoms of aspiration
• Health problem that can cause trouble swallowing
• GERD

The healthcare provider will ask about your child’s medical history and symptoms. This may be done by a speech-language pathologist (SLP). The SLP may ask about what foods or drink cause problems, and when your child’s symptoms happen. He or she may want to watch your child during a feeding.

Your child may also need tests. These can check for problems and show if food and fluid is going into your child’s lungs. The tests may include:

• Chest X-ray or CT scan
• Modified barium swallow test (MBS)
• Fiber optic endoscopic evaluation of swallowing (FEES)

Treatment for aspiration may vary depending on the cause and severity. Treatments for your child may include:

• Making changes in position and posture during meals
• Changing the thickness of liquids
• Changing the types of foods in your child’s diet
• Doing exercises to help with swallowing (for an older child)
• Medicines for GERD
• Medicines or Botox injection for children who make excess saliva
• Surgery to reduce reflux
• Surgery to correct a problem such as a cleft palate

If your child still has a high risk of aspiration despite these methods, he or she may need a special tube to help with eating for a while. The feeding tube will help your child get good nutrition until his or her risk of aspiration improves. Your child will not eat or drink normally until the tube is removed. A thin tube may be put through the nose down into the stomach. This is called a nasogastric tube. This may be used for a short time while other treatment is considered. Or a tube may be put directly into your child’s stomach during a surgery. This is called a gastrostomy tube.

In some children, aspiration lessens over time. In other cases, a child may need more treatment to address the cause. Your child’s healthcare providers will carefully watch your child so that he or she can return to normal eating as soon as possible.

Talk with your child’s healthcare provider if your child has a tracheostomy tube. You may need to suction food or liquid from the tube.

A major complication of aspiration is harm to the lungs. When food, drink or stomach contents make its way into your child’s lungs, it can damage the tissues there. The damage can sometimes be severe. Aspiration also increases the risk of pneumonia. This is an infection of the lungs that causes fluid to build up in the lungs. Pneumonia needs to be treated with antibiotics. In some cases, it may cause death.

Other possible complications from aspiration include:

• Dehydration
• Malnutrition
• Weight loss
• Increased risk of other illness

Let your child’s healthcare provider know right away if your child has any signs or symptoms of aspiration. It needs to be treated as soon as possible.