The relationship between aspiration during swallowing and respiratory tract illness in children

The relationship between aspiration during swallowing and respiratory tract illness in children
1 Feeding Clinic, Rehabilitation Centre for Children, Winnipeg, MB;
2 Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada

Background/Objectives: Recurrent aspiration during swallowing (ADS) is thought to have respiratory consequences; however, a causal relationship between the two has not been clearly established. This review was undertaken to assess whether ADS was associated with respiratory consequences in a diverse group of children presenting to a tertiary care feeding clinic for swallowing assessment.
Design: Case series, retrospective review.
Participants and Setting: The clinical and demographic data pertaining to two hundred and thirty-nine consecutive children (median age 15 months, 146 males) seen during a 2 year period who were evaluated by a video fluoroscopic swallow study in a tertiary care feeding clinic were reviewed.
Materials/Methods; A purpose-built data form was used to collate demographic and clinical information from the child’s medical records. Data was subjected to univariate and multi-variate analysis.
Results: Ninety-six (40%) of 239 children demonstrated aspiration during swallowing on video fluoroscopic swallowing study. Using univariate analysis, aspiration during swallowing was significantly correlated with cough during feeding (Odds Ratio (OR) 2.00; CI 1.18-3.29; P=0.001), congestion during or after feeding (OR 2.42; CI 1.37-4.29; P=0.002) and general respiratory traqct signs or symptons (including recurrent cough unassociated with feeding, asthma, lower respiratory tract infection or pneumonia) were correlated with aspiration (OR 1.85 CI 1.09-3.12; P=0.02). However, ADS and pneumonia, as documented on chest radiographs, were not significantly correlated using univariate analysis. With multi-variate analysis, adjusting for all significant variables in the univariate analysis, significant correlations with ADS include cough during feeding (OR 2.23; CI 1.24-4.01; P=0.007) and congestion during or after feeding (OR 2.07; CI 1.15-3.75; P=0.02). General respiratory tract signs or symptons which correlated with ADS during univariate analysis were not found to achieve significant correlation with ADS when subjected to multi-variate analysis.
Conclusions/Significance: While more good quality evidence is required, this review does not support a causal link between ADS and pneumonia. Cough and congestion are correlated with ADS and may be helpful to clinicians in diagnosing ADS. However, the significance of ADS as a cause of pneumonia needs to be questioned and carefully considered when developing oral feeding plans for children who demonstrate ADS. These results lay the foundation for a more detailed investigation regarding factors contributing to health and well being in children who aspirate during feeding.

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