Aspiration in Babies and Children- Signs, Tests, and 9 Tips to Prevent Aspirating

Today we are going to go over it in much more detail and exactly why having a safe swallow is so important.

What is aspiration in babies and children?

When a child aspirates it means that food or drink is going into their lungs instead of down the esophagus into the stomach. This can happen occasionally or anytime a child tries to eat or drink.  It primarily happens with thin liquids like breastmilk, formulas, and water….but it can happen with any liquid. Aspirating can be done on solid foods as well.  In severe cases, a child can aspirate on their own secretions (spit).

Aspiration has a higher chance of occurring when a child has dysphagia.  Dysphagia is a difficulty in swallowing.  Children with developmental delays or medical conditions are more likely to have dysphagia.  

What are the signs of aspiration in kids?

It is important to know that aspiration can occur during meal times and after the meals as well.  The main signs of aspiration include:

1. Choking and Coughing–  this one is the most obvious.  It is very noticable when a child will start choking and coughing during a meal.  This is the body trying to prevent liquids and solids from going into the lungs.
2. Appearance of Distress-  this may look like red watery eyes, red or pink flush to the face, or painful grimacing looks.
3. Breathing Changes-  a child can stop breathing while eating or starts breathing much faster than normal while eating or drinking. Wheezing and other breathing issues are common with aspiration as well.
4. Wet Vocal Sounds- while breathing or talking they will have a wet sound to their voice.
5. Slight Fever after eating-  this sign is very subtle and often missed, but a child may have a slightly elevated temperature after eating.
6. Weak Suck Reflex-  a weak suck and a weak control of their mouth is also a sign of a child that aspirates while eating.
7. Feeling like something is stuck- older children may complain that they feel like something is stuck in their throat.  They may also have the urge to vomit or have burps that bring food or acid back up.
8. Repeat Upper Respiratory Infections-  this is another sign that is often overlooked if you have multiple children.  It is so common for older siblings to bring common colds and viruses into the home and infect small children.  If you notice that your child seems to always have cold-like symptoms, they could be aspirating
9. No Symptoms at all-  This is truly the most scary sign of all.  Some children show no signs of aspirating at all, and this is referred to as “Silent Aspiration”.

If a child is aspirating, this will lead to aspiration pneumonia and can lead to pulmonary edema.  Pneumonia is an infection in the lungs that is treated with antibiotics.  Pulmonary edema is a build up of fluid in the lungs and the treatments is usually supplemental oxygen support and medications.  Other complications of aspiration can include dehydration, weight loss, malnutrition, and an increased risk for other illnesses.

How do you test a child for aspiration?

If you think that your child is aspirating while eating or drinking, you will need to inform your doctor or medical staff as soon as possible.  There are some tests that can be done to confirm aspiration and determine what is causing it.

• Chest X-rays will show if a child has aspiration pneumonia
• CT scan will also show pneumonia and any other damage to the lungs.
• Barium or Contrast Swallow Study– this is done in a radiology department.  The child is given either barium or contrast to swallow while the doctor takes a video x-ray of them swallowing.  This will show in real time if the liquid is going into the lungs.  Sometimes they will test different liquid thicknesses from very thin water consistency to a very thick honey consistency.
• FEES study– (Fiberoptic Endoscopic Evaluation of Swallowing) This is a test using a scope that goes into the nose and down the throat.  This can give a direct visual of the anatomy of the throat and esophagus and determine if there is something preventing a safe swallow. 

9 Tips to help prevent aspiration in babies and children

1. Keep your child in an upright 90 degree position while eating.  This can mean holding them in your arms in a upright manner while drinking a bottle or breastfeeding.  For older children, this could mean putting them in a high chair to help force them to sit upright.
2. Thickening Liquids–  there are lots of options to actually make the liquids that they drink thicker in order to have an easier time to swallow the liquids.  Some thickener options include adding infant cereal to breastmilk/formula, thickening agents like gelmix / thicken up/ thick-it, or avoiding super thin liquids like juice or water.
3. Changing Diet to soft foods– soft foods seem to do best when a child is aspirating so making changes to the diet to primarily be a soft consistency is usually an easy change.  Examples of soft foods would be mashed potatoes, canned fruits and vegetables, purees, pasta, and scrambled eggs.
4. Using a straw or spoon for thin liquids-  By using a straw or spoon to drink liquids like water and juice, it forces the mouth to take smaller sips and not gulp.
5. Oral Care- taking good care of your teeth and mouth is essential! Oral care helps kill harmful bacteria in your mouth, and if you have issues aspirating you will want the least amount of bad bacteria going into the lungs.
6. Speech Therapy-  a therapist will work to build good oral motor skills, teach exercises to strengthen mouth muscles used to swallow, and help practice chewing.
7. Eating very small– this can be done by taking very small bites or just cutting up food into very small pieces.  This reduces the likelihood of putting too much food in the mouth at one time.
8. Rested and Calm before meals–  it is important to eat when your child has the strength to do so and is not overly tired.  Eating while tired can make a child less likely to chew as well.  Also eating while calm can make a huge difference.  When an older child is distracted and talking while eating, it will make them focus less on chewing properly. 
9. Avoid sedatives and medications that cause dry mouth–  in some cases this is not avoidable, but if it is possible, you will want to try not to take these types of medications.  Sedatives cause a tiredness that can lead to lazy eating.  Lack of saliva while eating can lead to aspirating. 

How do you treat or stop aspiration?

If speech therapy and changing routines does not improve a child’s risk of aspiration, there are a few medical interventions that may help.  Typically aspiration is treated by finding out the source.  Once the source is identified, a treatment to fix that source can usually by done. 

For example, if a child is determined to be aspirating due to GERD, medications can be taken to help manage this condition. Another example is if a child makes too much saliva, botox injections can help slow down the saliva production. 

Another common cause of aspiration is a cleft palate, and there is surgery available to correct the palate. Severe cases may require surgery to create a flap to close the airway while swallowing. 

In the meantime, if a child is unable to swallow or eat safely, then a doctor will recommend having a feeding tube put in.  These can be done in the nose or in the stomach.  Once the source of the aspiration is corrected, then the feeding tube can usually be removed after a successful swallow study is completed.