Evaluation for Aspiration Disorders
What is aspiration?
Aspiration means that the while your baby is swallowing his /her feed or food ir accidently enters the airways causing choking, regurgitation, feeding difficulty and other symptoms which may be mild or severe.
When does one suspect aspiration?
Symptoms of aspiration are usually related to feeding times such as:
- coughing while drinking, particularly with thin liquids
- gagging during meals
- Feeding difficulties
- skin may turn slightly bluish colour while aspirating
- vomiting during or after feeding
- Noisy breathing
- Frequent cough and respiratory problems
- poor growth
What are the causes of aspiration?
Aspiration is usually associated with a difficulty in swallowing. It could be either: Oropharyngeal and Esophageal.
1: Oropharyngeal dysphagia
This occurs when the child has difficulty swallowing due to problems related to mouth, palate, tongue, , larynx, or the esophageal muscle. The underlying cause could be genetic diseases, developmental issues, neurologic conditions, or anatomical anomalies. Preterm babies or those who have undergone surgery are at a higher risk to develop this condition.
2: Esophageal dysphagia
This occurs when there is a delay or incomplete passage of food into the stomach due to inflammation related to neurological or muscular causes or as a post - surgical complication.
What is the management of aspiration?
In case your pediatrician or pediatric pulmonologist suspects this condition, the following tests may be advised:
- Clinical evaluation by history and examination
- Clinical feeding evaluation (CFE)
- Esophageal manometry
- Videofluoroscopic swallow study (VFSS), also known as a modified barium swallow study (MBS)
- Fiberoptic endoscopic evaluation of swallowing (FEES) exam.This is done by using a flexible bronchoscope. The child is fed milk and while he / she is feeding, the swallow reflex is observed by the bronchoscope which is positioned just above the glottis. The reflex is observed, coordination and sequence of the swallow is observed. Subsequently, aspiration into the lungs is ruled out by doing examination of the airways.