Pediatric Aspiration

What is aspiration?

Aspiration can occur during eating and/or drinking when food or liquid enters into the airway. In some cases this may develop into aspiration pneumonia. This can be due to poor coordination, timing, and or structural changes in the swallowing muscles. Some signs of aspiration include: coughing, throat clearing, wet vocal quality, choking, fever, and discoloration of face (e.g., redness or blue) during or briefly after swallowing.



How is aspiration diagnosed?

Diagnosis can be made by a speech-language pathologist (SLP) during a clinical swallow evaluation, fiberoptic endoscopic evaluation of swallowing, and/or modified barium swallow study. During each assessment the SLP may ask the patient to trial different strategies to see if they are effective  at reducing or eliminating the signs of aspiration. 

  • Clinical Swallow Evaluation –This is a subjective evaluation were the SLP observes a patient eating a variety of foods consistencies (e.g. purees, soft solids, regular consistency) and liquids to assess for signs of aspiration
  • Fiberoptic Endoscopic Evaluation of Swallowing – This assessment is completed by an otolaryngologist (ENT) and SLP by using a fiberoptic scope that is passed through the nasal cavity, to the pharynx,  and above the larynx. While the scope is superiorly positioned, the SLP will ask the patient to eat and drink a variety of foods and liquids. In this view the ENT and SLP can assess the structure and anatomy of swallowing and observe any food or liquids entering into the airway. Some changes that may impact a patient swallowing include inflammation, vocal cord paralysis, laryngomalacia, laryngeal cleft,.
  • Modified Barium Swallow Study – This evaluation is completed by a radiologist and SLP. The patient is seated in an upright position and an x-ray video is taken while the patient trials a variety of food and liquid consistencies containing barium. The radiologist and SLP can visualize the food/liquid as it enters the patients mouth to the opening of the esophagus. The team also can visualize if any of the foods or liquids enter the patient’s airway.  



How is aspiration treated?

After the evaluation(s), the SLP will provide recommendations based on the various findings. These may include modifications to diet consistency, thickening  of liquids, use of compensatory strategies (e.g., taking small bites or sips, turning the patient’s head to the left or right, swallowing with increased effort, chin tuck, and taking a dry swallow), and in some cases avoidance of eating or drinking  by mouth. If the patient cannot eat or drink  by mouth other means of nutrition and hydration are necessary.

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