Silent aspiration prominent in children with dysphagia

Arvedson, Joan C.; Rogers, Bonnie; Buck, Germaine M.; Smart, Paulette; Msall, Michael E.

doi:10.1016/0165-5876(94)90009-4

Cited by 222 publications

(176 citation statements)

References 14 publications

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“…The medical records and VFSS results of 150 children who attended a VFSS at the Royal Children's Hospital, Brisbane (Australia) between April 11, 2001 and August 4, 2004 were reviewed retrospectively and have been previously described [14,15]. Briefly, children's medical files, VFSS referrals and results of clinical feeding evaluations were reviewed for clinical signs or symptoms associated with OPA and swallowing dysfunction during feeding.…”

Section: Methodsmentioning

confidence: 99%

Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children

Weir¹,

McMahon²,

Barry³

et al. 2008

Eur Respir J

115

111

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The diagnostic value of various signs and symptoms (clinical markers) in predicting oropharyngeal aspiration (OPA) or swallowing dysfunction has not been established in children. The present retrospective study was undertaken to: 1) identify specific clinical markers associated with radiographic evidence of OPA, isolated laryngeal penetration (ILP) and postswallow residue (PSR); 2) determine the sensitivity and specificity of clinical markers associated with OPA; and 3) determine the influence of age and neurological impairment on clinical markers of OPA.In total, 11 clinical markers of dysphagia were compared with the videofluoroscopic swallow study (VFSS) results (OPA, ILP and PSR) in 150 children on diets of thin fluid and purée consistencies. Chi-squared and logistic regression were used to analyse the association between clinical markers and VFSS-identified swallowing dysfunction.In children with OPA, wet voice (odds ratio (OR) 8.90, 95% confidence interval (CI) 2.87-27.62), wet breathing (OR 3.35, 95% CI 1.09-10.28) and cough (OR 3.30, 95% CI 1.17-9.27) were significantly associated with thin fluid OPA. Predictive values included: wet voice (sensitivity 0.67; specificity 0.92); wet breathing (sensitivity 0.33; specificity 0.83); and cough (sensitivity 0.67; specificity 0.53). No clinical markers were significantly associated with OPA, ILP or PSR on the purée consistency. Cough was significantly associated with PSR on thin fluids (OR 3.59, 95% CI 1.22-10.55). Differences were found for age.Wet voice, wet breathing and cough were good clinical markers for children with oropharyngeal aspiration on thin fluid but not on purée. Age and neurological status influenced the significance of these clinical markers.

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Section: Methodsmentioning

confidence: 99%

Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children

Weir¹,

McMahon²,

Barry³

et al. 2008

Eur Respir J

115

111

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“…12 Hypoxemia may occur during oral feeding. 13 The risk of aspiration in children with CP can decrease over time as developmental gains are made, although it is not unusual for children to show increased signs of dysphagia as they reach puberty, at which time changes in nutritional needs occur as well as possible increased scoliosis or kyphosis.…”

Section: Types Of Swallowing and Feeding Problems In Children With Cpmentioning

confidence: 99%

Feeding children with cerebral palsy and swallowing difficulties

2013

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Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.European Journal of Clinical Nutrition (2013) 67, S9-S12; doi:10.1038/ejcn.2013.224Keywords: cerebral palsy; dysphagia; pediatrics; feeding; swallowing INTRODUCTIONChildren with cerebral palsy (CP) commonly have feeding disorders and swallowing problems (dysphagia) that in many instances place them at risk for aspiration with oral feeding, with potential pulmonary consequences. They also commonly have reduced nutrition/hydration status and prolonged stressful meal times. The specific nature and severity of the swallowing problems may differ, at least to some degree, in relation to sensorimotor impairment, gross and fine motor limitations, and cognitive/ communication deficits. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits 1,2 than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. 3 Concerns are multifactorial and include issues of reduced volume of food and liquid consumed orally, nutrition deficits, inadequate hydration and limited range of textures with slow advance of oral skills.Children with moderate-to-severe dysphagia usually are managed most effectively with an interdisciplinary team that allows for multiple factors to be addressed in a coordinated way. These factors include, but are not limited to, gastrointestinal issues, pulmonary status, nutrition/hydration, oral sensorimotor skills, behavioral issues and family interactions. The importance of a structured approach is stressed to handle these multiple problems. 4 It is critical that all decisions for the management of feeding and swallowing problems are made in consideration of the primary needs of the child that is, a stable airway with adequate nutrition and hydration. In addition, any feeding/ swallowing intervention should be pleasurable and non-stressful for patients and care givers. In some instances, tube feeding may be needed either temporarily or long term. [5][6][7][8] It is expected, with rare exceptions, that these children can cope with at least minimal tastes for pleasure, a practice that may have a positive impact on management of saliva/secretions while maintaining oral function and swallowing.This review paper is focused on dysphagia: types of deficit...

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“…Food or gastric content aspirated into the airways can cause laryngeal, tracheal, and bronchial inflammation resulting in stridor, cough, wheezing, recurrent pneumonia, bronchiectasis, pulmonary fibrosis, and even suffocation and death due to massive aspiration (3,13,14). In neurologically handicapped children, aspiration is common, due either to massive gastroesophageal reflux (1,2) or to aspiration from above due to noncoordination between breathing and swallowing mechanisms (15). Aspiration secondary to swallowing dysfunction may also occur in neurologically normal infants.…”

Section: Discussionmentioning

confidence: 99%

“…Three hamsters were used as naive controls (without tracheal instillation). Five animals from the PLGA and three of the saline groups were killed and underwent WLL on days 1,8,15,29,43, and 58 after tracheal instillation. The naive animals were killed on day 1, and WLL was performed.…”

Section: Animalsmentioning

confidence: 99%