Feeding therapy appears effective for most kids with normal anatomy, chronic aspiration

Last Updated: 2015-11-03

By Anne Harding

NEW YORK (Reuters Health) - Feeding and swallowing therapy appears to help resolve chronic aspiration in most children with normal airway anatomy, according to new findings.

However, this therapy is less likely to be successful in syndromic children and children with significant neurological comorbidities, Dr. Reza Rahbar of Boston Children's Hospital and colleagues found.

Chronic aspiration can permanently damage the lungs of infants and children, Dr. Rahbar and his team note in their report, online October 22 in JAMA Otolaryngology-Head & Neck Surgery. Aspiration may be due to anatomic abnormalities, discoordinated swallow reflex, or both, they add.

Evaluation should include tests to determine the degree of aspiration, such as a modified barium swallow (MBS) study or fiberoptic endoscopic evaluation of swallowing, according to Dr. Rahbar and his team. Upper airway endoscopy should also be done to identify any anatomic abnormalities, they say, and gastroenterologic assessment and pulmonary assessment are also valuable.

For children who don't have anatomic abnormalities in the upper airway, the researchers write, "caregivers often question the need for further evaluation, management options, duration of treatment, and outcomes."

To investigate these issues, Dr. Rahbar and his colleagues performed a retrospective medical record review of patients with normal anatomy treated at their center between 2002 and 2012.

They identified 46 patients, mean age 1.56 years at presentation, with a range of six weeks to eight years. Eight of the patients had a recognized syndrome, 16 had developmental delay, and 12 had congenital heart disease. Gastroesophageal reflux disease (GERD) was documented in three patients, and suspected in 33. Six of the patients had no comorbidity.

All of the patients underwent feeding and swallowing therapy. Among the 25 who aspirated thin liquids only, 84% were free of aspiration at their last MBS. The mean duration of therapy in successfully treated patients was 7.68 months.

Treatment was successful in 80% of the 15 patients who aspirated thickened liquids, and lasted 11.04 months. Patients in both groups who weren't treated successfully with feeding therapy required gastrostomy tube placement.

Half of the six patients who aspirated purees were treated successfully with feeding and swallowing therapy, which lasted 1.72 years on average.

Three of the study participants required tracheostomy, all of whom had recurrent pneumonia and neuromuscular disorders.

"The investigation and treatment of swallowing problems in children are challenging," Dr. Rahbar and colleagues conclude. "Early diagnosis and intervention, including feeding and swallowing therapy, are extremely important to support optimal growth and to prevent pulmonary complications."

SOURCE: http://bit.ly/1XLqHoY

JAMA Otolaryngol Head Neck Surg 2015.