Understanding Aspiration (Child)

Upper body of infant showing respiratory anatomy, esophagus and stomach.Aspiration is when something enters the airway or lungs by accident. It may be food, liquid, or some other material. This can cause serious health problems, such as pneumonia. Aspiration can happen when a person has trouble swallowing normally. This is known as dysphagia. It can also happen if a child has gastroesophageal reflux disease (GERD). This is when the contents of the stomach come back up into the throat.

What happens when your child swallows

When your child swallows food, it passes from the mouth down into the throat. This is called the pharynx. From there, the food moves down through a long tube (esophagus) and into the stomach. This journey is made possible by a series of actions from the muscles in these areas. If your child has dysphagia, the muscles don’t work normally. They cause problems with the swallowing process.

The pharynx is also part of the system that brings air into the lungs. When a person breathes, air enters the mouth and moves into the pharynx. The air then goes down into the main airway (trachea) and into the lungs. A flap of tissue called the epiglottis sits over the top of the trachea. This flap blocks food and drink from going down into the trachea when your child swallows. But in some cases, food or drink can enter the trachea. It may go down as your child swallows. Or it may come back up from the stomach. A child with dysphagia is much more likely to aspirate. A child with a developmental or health problem is more likely to have dysphagia.

What causes aspiration

Certain conditions can increase a child’s risk for aspiration, such as:

  • Contents of the stomach coming back up into the throat (gastroesophageal reflux disease or GERD)

  • Abnormal anatomy, such as a cleft palate or a problem in the esophagus

  • Delayed growth, from premature birth or a condition such as Down syndrome

  • Brain damage or other problems, such as from cerebral palsy or infection

  • Problems with the cranial nerves that control the muscles of swallowing

  • Neuromuscular disease, such as spinal muscular atrophy

  • Medical procedures, such as a nasogastric tube or a tracheostomy

Signs and symptoms of aspiration

Aspiration can cause signs in a baby such as:

  • Weak sucking

  • Choking or coughing while feeding

  • Other signs of feeding trouble, like a red face, watery eyes, or facial grimaces

  • Stopping breathing while feeding

  • Faster breathing while feeding

  • Voice or breathing that sounds wet after feeding

  • Slight fever after feedings

  • Wheezing and other breathing problems

  • Repeated lung or airway infections

Aspiration can cause signs and symptoms in an older child such as:

  • Choking or coughing while eating

  • Voice that sounds wet after eating

  • Slight fever after meals

  • Complaints of food feeling stuck or coming back up

  • Wheezing and other breathing problems

  • Repeated lung or airway infections

Signs and symptoms can happen right after eating. Or they may happen over time. Your child may not have all of these signs and symptoms. The signs and symptoms may depend on the age of your child, and how often and how much your child aspirates.

Some children who aspirate do not have any signs or symptoms. This is called silent aspiration.

Diagnosing aspiration

Your child will need to be checked for aspiration if he or she has:

  • Any signs or symptoms of aspiration

  • Health problem that can cause trouble swallowing

  • GERD

The healthcare provider will ask about your child’s health history and symptoms. This may be done by a speech-language pathologist (SLP). The SLP may ask about what foods or drink cause problems, and when your child’s symptoms occur. He or she may want to watch your child during a feeding.

Your child may also need tests. These can check for problems and show if food and fluid is going into your child’s lungs. The tests may include:

  • Chest X-ray or CT scan

  • Modified barium swallow test (MBS)

  • Fiberoptic endoscopic evaluation of swallowing (FEES)

  • Nuclear medicine scans