eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Aspiration Syndromes: Follow-up

Author: Cecilia P Mikita, MD, MPH, Associate Program Director, Allergy-Immunology Fellowship, Chief, Clinical Services, Allergy-Immunology Clinic, Walter Reed Army Medical Center
Coauthor(s): Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Apr 21, 2008

Follow-up

Further Inpatient Care

  • Admit infants and children with aspiration syndromes if a documented oxygen requirement is noted, if the patient has altered mental status, or if adequate medical care is unable to be met in the outpatient arena.

Further Outpatient Care

  • Patients should be seen by their primary care manager for routine well-child visits and regularly for follow-up care.

Inpatient & Outpatient Medications

Transfer

  • Admit to the intensive care unit if the patient requires intubation, shows signs of impending respiratory failure, or shows instability on the ward with requirement of closer monitoring.

Deterrence/Prevention

  • Conservative measures are the best deterrence against gastroesophageal reflux (GER). Attention to feeding volumes, positioning, and encouragement of breastfeeding may be helpful to decrease GER signs and symptoms in infants.

Complications

  • Chronic lung disease may develop from repeated aspiration of refluxate.
  • Pulmonary fibrosis may occur over time secondary to repeated aspiration of small volumes of gastric secretions, promoting a progressive fibrotic pulmonary response.
  • Chronic bronchitis and bronchiectasis are also recognized complications.

Prognosis

  • In general, the prognosis for an infant or child with an aspiration syndrome is good; but this depends partly on the underlying disorder.
  • GER spontaneously resolves in most children by age 1-2 years.

Patient Education

  • Educate patient and family regarding basic and conservative measures to prevent GER and ensuing complications.
  • For excellent patient education resources, visit eMedicine's Procedures Center. Also, see eMedicine's patient education article Bronchoscopy.

Miscellaneous

Medicolegal Pitfalls

  • Evaluate patients who have clinical symptoms of obstructive pulmonary disease not responsive to therapy for gastroesophageal reflux (GER) and pulmonary disease.
  • One must remember that GER may exacerbate respiratory symptoms in a patient with correctly diagnosed pulmonary disease.
  • Providers may be dissuaded by negative diagnostic studies or negative history of regurgitation in the child.
  • Barium swallow and scintigram may both be negative, even in the face of significant reflux. These studies are most helpful when positive but have very poor negative predictive value.
  • Evaluate episodes of ALTEs because they could possibly be caused by GER.
  • Chronic aspiration syndromes may mask disorders such as cystic fibrosis, bronchopulmonary dysplasia, immune deficiency, interstitial lung disease, and asthma.

Special Concerns

  • Children with neurological disorders may need surgical treatment, in addition to conservative and medical management.
 


More on Aspiration Syndromes

Overview: Aspiration Syndromes
Differential Diagnoses & Workup: Aspiration Syndromes
Treatment & Medication: Aspiration Syndromes
Follow-up: Aspiration Syndromes
Multimedia: Aspiration Syndromes
References
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References

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Further Reading

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Keywords

aspiration syndromes, aspirate, aspiration into the lungs, gastroesophageal reflux, GER, swallowing dysfunction, neurological disorders, neurologic disorders, structural abnormalities, fluid aspiration, foreign body aspiration, foreign substance aspiration, pneumonia, aspiration pneumonia, deglutition pneumonia, bronchopneumonia, cricopharyngeal dysfunction, cricopharyngeal incoordination of infancy, transient pharyngeal muscle dysfunction, superior laryngeal nerve damage, vocal cord paralysis, cerebral palsy, muscular dystrophy, Riley-Day syndrome, familial dysautonomia

anatomic disorders, cleft palate, esophageal atresia, tracheoesophageal fistula, duodenal obstruction, malrotation, motility disorders, achalasia, microaspiration, asthma, gastroenteritis, eosinophilic esophagitis, pharyngeal dysphagia, nasopharyngeal reflux, sudden infant death syndrome, acute life-threatening episode, ALTE, recurrent wheezing, apnea, chronic cough, recurrent pneumonia, upper respiratory infection, URI, obstructive apnea, bronchorrhea, failure to thrive, stridor, hoarseness, night sweats, purulent sputum, bronchopulmonary dysplasia, pulmonary abscess, pulmonary fibrosis, bronchiectasis, fever, tachypnea, small airway obstruction, pneumonitis 

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Contributor Information and Disclosures

Author

Cecilia P Mikita, MD, MPH, Associate Program Director, Allergy-Immunology Fellowship, Chief, Clinical Services, Allergy-Immunology Clinic, Walter Reed Army Medical Center
Cecilia P Mikita, MD, MPH is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, and Clinical Immunology Society
Disclosure: Nothing to disclose.

Coauthor(s)

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Medical Editor

Thomas Scanlin, MD, Chief, Division of Pediatric Pulmonary & Cystic Fibrosis, Assistant Professor, Department of Pediatrics, Robert Wood Johnson University Medical Group
Thomas Scanlin, MD is a member of the following medical societies: American Thoracic Society and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Heidi Connolly, MD, Associate Professor of Pediatrics and Psychiatry, University of Rochester;Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center
Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Associate Professor, Department of Clinical Pediatrics, State University of New York at Stony Brook
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics, American Heart Association, and American Thoracic Society
Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD, Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center; Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

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