Aspiration in Children

What is aspiration?

Your child may aspirate when problems with swallowing causes food or liquid to enter your child’s lungs.

What are the symptoms of aspiration in children?

If your child aspirates, they may start choking. Aspirating can also cause other symptoms including:

  • difficulty feeding
  • coughing when drinking, particularly with thin liquids
  • gagging during meals
  • back arching during feeding
  • skin turning a bluish color
  • redness around the eyes during or after feeding
  • vomiting during feeding
  • rattling in the throat or chest
  • frequent breathing problems
  • poor growth

What causes a child to aspirate?

Aspirating is usually the result of dysphagia, which means difficulty swallowing. There are two types of dysphagia: oropharyngeal and esophageal.

  • Oropharyngeal dysphagia occurs when your child has difficulty swallowing because of problems with their mouth, tongue, palate, larynx, or the muscle at the top of the esophagus. Oropharyngeal dysphagia can be caused by developmental issues, neurologic conditions, genetic syndromes, or problems with anatomy. Children who are born prematurely or who have had surgery on the heart, lungs, or chest may also have a higher risk for the condition. However, some children with oropharyngeal dysphagia do not have these risk factors.
  • Esophageal dysphagia occurs when the esophagus does not clear food appropriately because of inflammation, because of a nerve or muscle problem, or because of prior surgeries.

Your care team can help determine what type of dysphagia your child has.

How is aspiration diagnosed and treated?

If your child’s doctor suspects the aspiration is due to dysphagia, they may perform one or more tests to evaluate swallowing, including:

  • physical examination and medical history
  • clinical feeding evaluation (CFE) with a speech language pathologist who specializes in pediatric feeding and swallowing disorders
  • esophageal manometry
  • videofluoroscopic swallow study (VFSS), also known as a modified barium swallow study (MBS)
  • fiberoptic endoscopic evaluation of swallowing (FEES) exam

Your child’s doctor may suggest you change the way your child feeds to reduce the chance that food will enter their lungs by mistake. For example, you may need to add thickener to their liquids, or they may need to eat or drink more slowly or in a different position. In rare cases, they may need to receive liquids by a tube through their nose or stomach.

How we care for aspiration in children

The skilled clinicians in the Aerodigestive Center and Center for Airway Disorders at Boston Children’s Hospital are experienced in diagnosing and treating children with a range of aerodigestive concerns, including aspiration. We have a rich understanding of the complexity of the swallowing process, which allows us to consider all aspects of this mechanism when evaluating and treating aspiration and its causes.

Working together to address aspiration

Although Mia was born prematurely, she initially appeared healthy but then began aspirating when she fed, causing liquid to enter her lungs.

Mia initially appeared healthy but then began aspirating when she fed, causing liquid to enter her lungs.