Micro-aspiration (in Apparently Neurologically Typical Children)

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(Adapted from Pocket Guide to Alaska Native Pediatric Diagnoses)
Pathophysiology: Unknown
Demographics: Unknown, but appears to be a significant number of otherwise normal children under age 3 from Western or Northern Alaska
Signs/Symptoms:

  • Overt signs/symptoms not always present
  • frequent cough
  • aspiration with feeds during URIs
  • frequent (or any) pneumonia, especially right upper lobe

Diagnosis: Clinical vs Video Fluoroscopic Swallow Study (VFSS) evaluation. The radiation exposure from VFSS as well as the cost of transporting patients to Anchorage are higher risk and cost than initially treating symptomatic patients
Management:

  • Slow-flow nipple. Change to Dr. Brown level 1 or Dr. Brown Preemie nipple to slow down flow rate. Ensure that families do not cut or alter nipples in any way
  • Thicken liquids to nectar thick (using Thick-it). If flow is too slow once feeds are thickened, try Dr. Brown's Level 2 or 3.
  • If still experiencing overt symptoms of aspiration or if no resolution of lung disease within 3 months of proactive thickening, child should be referred to ANMC for a VFSS or modified barium swallow study
  • Continue thickened liquids until the patient experiences 12 symptom free months, then gradually wean off thickener. If child does not tolerate wean, refer to ANMC for swallow evaluation.

Risks of Proactive Thickening

  • Child's swallow pattern may not change; child may still be aspirating but with reduced signs and symptoms
  • if above is true, child is now aspirating corn starch and additional sugar from thickener.
  • if still aspiration, the heavier consistency of thickened liquids make them more difficult to clear via spontaneous cough

Critical Times for Affected Patients: Respiratory illness in infancy

Resources


Common/Unique Medical Diagnoses