Aspiration/Chronic Lung Disease

Children with CP and other chronic disorders are at risk for acute and chronic respiratory illness due to neurological and anatomical dysfunction. Recurrent pneumonia can be a frequent, often unrecognized, sign of aspiration. Although pneumonia may occur as an isolated illness in any child, it should prompt consideration for further evaluation in a child with CP.

Factors contributing to aspiration in children with chronic illness include oral motor dysfunction, gastroesophageal reflux, sleep apnea, seizures, atelectasis/bronchiectasis, tracheal malacia, restrictive lung disease, airway hyposensitivity, ineffective cough, inadequate seating posture, and scoliosis.

Optimal management of the child includes:

• Minimizing aspiration risk
• Optimizing nutrition
• Immunizing - including influenza and pneumococcal vaccines
• Ensuring good posture support in seating
• Monitoring for scoliosis
• Avoiding active/passive tobacco smoke

Monitor for symptoms of, evaluate for, and manage problems associated with:

• Dysphagia/aspiration
• Gastroesophageal reflux
• Sleep apnea/obstruction
• Comorbid pulmonary conditions (e.g., asthma, allergies, BPD).

Refer to a pediatric gastroenterologist, pulmonologist, or sleep specialist for further evaluation/intervention if indicated.