Aspiration can be defined as entry of material into the airway below the true vocal cords.
Aspiration can occur when there are problems with swallowing and/or in conjunction with gastroesophageal reflux (GER). Aspiration can result from a primary swallowing dysfunction or from lack of coordination between sucking, swallowing, and breathing. Infants with increased respiratory rate may be at increased risk of aspiration.
Respiratory consequences of aspiration can be severe. When aspiration is suspected, families should be promptly referred for further diagnosis and treatment.
Feeding Behavior: Coughing or choking during swallowing or noisy or "wet" respirations can indicate that liquid is impinging on the airway. This can be liquid that is actually aspirated into the airway or that merely penetrates the airway and then is expelled. It is important to note that aspiration can also be "silent."
History: Infants with aspiration may have cough, wheeze, and tachypnea during or after feedings. Recurrent aspiration may lead to secondary infection and pnuemonia. Left untreated, infants with aspiration may develop stridor, persistent atelectasis, bronchiectasis with chronic productive cough and failure to thrive. Some infants may have difficulty handling oral secretions.
Videofluoroscopic Swallowing Study (VFSS): VFSS is used to document occurrence of aspiration, reasons for aspiration, and possible therapies for aspiration. The infant is given breastmilk or formula mixed with liquid barium. The infant is placed in a feeding seat and the fluoroscope table is tilted so that the response of the pharyngeal area during feeding can be captured as a permanent video image.
- Treatment of GER. Please see section on gastroesophageal reflux.
- Modification of the food or feeding positioning: Sometimes VFSS shows that an infant can swallow thickened feeds, foods with temperature alterations, or foods with other changes in characteristics. In this case modified feedings may be given. Commercial thickeners are contraindicated in infants under 1 year of age due to evidence that they put infants at risk of developing necrotizing enterocolitis. Infant oatmeal is the preferred cereal to use as thickening agent due to the high arsenic content of infant rice cereal and possible health effects of prolonged exposure of large quantities. Adequate fluid, energy, and nutrient intake should be assured when modifications are made. This treatment should always be frequently and carefully monitored. Infants with nippling problems or GER may have difficulties with thickened feedings. Adequacy of fluid intake should be assured when feedings are thickened. For more information, see Feeding and Swallowing Disorders in Infancy by Wolf and Glass.
- Pacing of feedings: Caregivers may promote more appropriate coordination of suck-swallow-breathe by helping the infant to "pace" the feeds. Referral to a feeding therapist is appropriate for further assessment and for caregivers teaching.
- Elimination of oral feedings: Aspiration that cannot be successfully treated in other ways may require at least temporary elimination of oral feedings. In this case, referral for ongoing therapies to maintain appropriate development of oral motor skills is essential if oral feedings are to be successfully reinstated.
- Infants at risk for aspiration associated with BPD and increased respiratory rate should be referred to a specialist for management of BPD.
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Page reviewed: March 24, 2015