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. Pneumonia or recurrent pneumonias are 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 the child with CP.

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

Optimal management of the child with CP includes:

• Minimizing pulmonary risk;
• Optimizing nutrition;
• Appropriately Immunizing - some children may benefit from influenza and pneumococcal vaccines;
• Insuring good posture support in seating;
• Monitoring for scoliosis; and
• Educating the family to avoid active/passive tobacco smoke.

Monitor for symptoms of, evaluate, and manage associated problems as clinically indicated:

• dysphagia/aspiration;
• gastroesophageal reflux;
• sleep apnea/obstruction; and
• comorbid pulmonary conditions (e.g., asthma, allergies, BPD).

Refer to a pediatric pulmonologist for further evaluation/intervention if indicated.