Aspirations occurs when food, drink, foreign material or gastric juices are breathed into the larynx or the lower respiratory tract (instead of going through the food pipe, they end up going through the wrong tube). Aspirations can also be silent, without any outward sign of swallowing difficulty. If aspirations are untreated it can result in recurrent pneumonia, bronchiolitis or failure to thrive.
As speech pathologists we play a significant role in (1) identifying aspirations in high-risk children, (2) planning intervention strategies to prevent aspiration and (3) make appropriate referrals.
Causes for Aspiration
Several pulmonary syndromes may occur after aspiration, depending on the amount and nature of the aspirated material, the frequency of aspiration, and the child’s response to the aspirated material. Therefore, it is essential for us to understand the causes, which can further enable us plan the right interventions and recommend appropriate referrals.
Signs and symptoms of aspiration
A thorough clinical examination is essential to identify signs and symptoms which include, but are not limited to: chocking, gagging, reflux, vomiting, poor feeding, slow feeding, coughing, noisy breathing, congestion, respiratory distress, and recurrent pneumonia.
In order to understand the severity of aspirations, a video of the child feeding/ being fed at home may be requested along with a three-day meal chart during an assessment. The parent can also bring food to feed the child in front of a therapist, so that the clinician will able to ascertain severity and design/ customise a therapy plan accordingly.
The first and foremost in intervention is to prevent aspirations using methods as suggested below; however, if aspirations persist even after a week, medical referral must not be tarried.
1. Breath support
Breathing is the body’s number one priority. We breathe and swallow at the same time with ease. What seems effortless for most of us can be difficult for children with breathing problems. Food and air have the same passage until food reaches the pharynx; therefore, careful consideration to breath support is important and when managed the right way, can prevent aspirations. How to improve breath support? The answer is to improve postural stability for optimal breathing.
2. Postural Stability
If a child is unable to sit without support or stoops or bends forward compressing the stomach there are high chances s/he is aspirating.
What you must do: Have the child seated in an upright posture with an approximate 90-degree angle at the ankles, knees, truck and chin as illustrated in picture (a). Postural stability can help improve breath support and synchronises breathing and swallowing, which are crucial for safe swallow. Add support using cushions or support manually if required. Children who are unable to sit upright can be assisted to lie prone or on a therapy ball or a mat as illustrated in the image (b).
Yet another significant method to prevent aspirations is to facilitate the child turn their head to one side during a swallow, which can prevent aspirations.
3. Use appropriate tools in Intervention
Feeding bottles with a wrong nipple size or nipple whole, large spoon bowls, large open cups are some of the commonly used tools that may increase the risk of aspiration in young children.
As a feeding expert, FIRSTLY, my recommendation is to avoid using feeding bottles for infants older than 7-8 months, and substitute it with a straw or an open cup depending on the child’s abilities.
SECONDLY, use spoons with a bowl size smaller or equalling the corners of the child’s lips. A pre spoon as illustrated in picture (c) may also be used for better proprioceptive input and oral motor control, and to limit the quantity of food placed on the spoon.
LASTLY, use open cups that have a smaller opening close to a quarter of the child’s face. This will avoid spilling, and limit the amount and speed of water/liquids rushing into the mouth.
If a child continues to aspirate on pureed foods in spite of minimal quantity of food placed on the spoon, having the head turned while eating or positioning; a medical recommendation is mandatory. A wait and watch approach is to be discouraged, and medical Intervention must be recommended at the earliest.
Presenting symptoms vary in children with aspirations depending on the severity of an underlying medical condition and as such, cannot be relied on observation alone; hence, an objective study must be recommended along with a gastroenterologist referral. A gastroenterologist may recommend tube feeding, or recommend medication to reduce gastric acid production or to improve gastrointestinal motility, depending on the severity.
I hope this information has helped you understand what are aspirations, their causes and how to prevent them. Connect with your speech language pathologist and a gastroenterologist for more help.
Chief Speech Language Pathologist