Aspiration Syndromes Follow-up

  • Author: Cecilia P Mikita, MD, MPH; Chief Editor: Michael R Bye, MD   more...
 
Updated: Apr 26, 2012
 

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.
Next

Further Outpatient Care

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

Inpatient & Outpatient Medications

  • See Medication.
Previous
Next

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.
Previous
Next

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.
Previous
Next

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.
Previous
Next

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.
Previous
Next

Patient Education

  • Educate patient and family regarding basic and conservative measures to prevent GER and ensuing complications.
  • For patient education resources, see the Procedures Center, as well as Bronchoscopy.
Previous
 
Contributor Information and Disclosures
Author

Cecilia P Mikita, MD, MPH  Associate Program Director, Allergy-Immunology Fellowship, Associate Professor of Pediatrics and Medicine, Uniformed Services University of the Health Sciences; Staff Allergist/Immunologist, Walter Reed National Military 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.

Specialty Editor Board

Thomas Scanlin, MD  Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Heidi Connolly, MD  Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; 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.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center; Professor 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 and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

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: Nothing to disclose.

References

  1. Rudolph CD, Mazur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB, et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001;32 Suppl 2:S1-31. [Medline].

  2. de Benedictis FM, Carnielli VP, de Benedictis D. Aspiration lung disease. Pediatr Clin North Am. Feb 2009;56(1):173-90, xi. [Medline].

  3. Callahan CW. Increased gastroesophageal reflux in infants: can history provide an explanation?. Acta Paediatr. Dec 1998;87(12):1219-23. [Medline].

  4. Callahan CW, Sisler C. Use of seating devices in infants too young to sit. Arch Pediatr Adolesc Med. Mar 1997;151(3):233-5. [Medline].

  5. Callahan CW. The diagnosis of gastroesophageal reflux in hospitalized infants: 1971-1995. J Am Osteopath Assoc. Jan 1998;98(1):32-4. [Medline].

  6. Orenstein D. Aspiration pneumonias and gastroesophageal reflux - related respiratory disease. In: Nelson Textbook of Pediatrics. 15th ed. Elsevier Science;1996:1213-1215.

  7. Orenstein SR. Gastroesophageal reflux. Pediatr Rev. Jan 1999;20(1):24-8. [Medline].

  8. Orenstein SR, Orenstein DM. Gastroesophageal reflux and respiratory disease in children. J Pediatr. Jun 1988;112(6):847-58. [Medline].

  9. Nelson SP, Chen EH, Syniar GM, Christoffel KK. One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatric Practice Research Group. Pediatrics. Dec 1998;102(6):E67. [Medline].

  10. Richter JE. Extraesophageal presentations of gastroesophageal reflux disease. Semin Gastrointest Dis. Apr 1997;8(2):75-89. [Medline].

  11. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol. Jan 2004;113(1):11-28; quiz 29. [Medline].

  12. Yoshikawa H, Yamazaki S, Abe T. Acute respiratory distress syndrome in children with severe motor and intellectual disabilities. Brain Dev. Sep 2005;27(6):395-9. [Medline].

  13. Kohda E, Hisazumi H, Hiramatsu K. Swallowing dysfunction and aspiration in neonates and infants. Acta Otolaryngol Suppl. 1994;517:11-6. [Medline].

  14. Carre IJ. The natural history of the partial thoracic stomach (hiatus hernia) in children. Arch Dis Child. Aug 1959;34:344-53. [Medline].

  15. Model J, Boysen P. Pulmonary aspirations of stomach contents. In: The Society of Critical Care Medicine Textbook of Critical Care. Philadelphia, Pa:. WB Saunders Co;1984:272-274.

  16. Albanese CT, Towbin RB, Ulman I, Lewis J, Smith SD. Percutaneous gastrojejunostomy versus Nissen fundoplication for enteral feeding of the neurologically impaired child with gastroesophageal reflux. J Pediatr. Sep 1993;123(3):371-5. [Medline].

  17. Takamizawa S, Tsugawa C, Nishijima E, Muraji T, Satoh S. Laryngotracheal separation for intractable aspiration pneumonia in neurologically impaired children: experience with 11 cases. J Pediatr Surg. Jun 2003;38(6):975-7. [Medline].

  18. Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseglia A, Strisciuglio P. Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey. Pediatrics. Mar 2009;123(3):779-83. [Medline].

  19. Chang AB. Cough: are children really different to adults?. Cough. Sep 20 2005;1:7. [Medline].

  20. Darrow DH, Harley CM. Evaluation of swallowing disorders in children. Otolaryngol Clin North Am. Jun 1998;31(3):405-18. [Medline].

  21. Derkay CS, Schechter GL. Anatomy and physiology of pediatric swallowing disorders. Otolaryngol Clin North Am. Jun 1998;31(3):397-404. [Medline].

  22. Goldsobel AB, Chipps BE. Cough in the pediatric population. J Pediatr. Mar 2010;156(3):352-8. [Medline].

  23. Harding SM, Richter JE. The role of gastroesophageal reflux in chronic cough and asthma. Chest. May 1997;111(5):1389-402. [Medline].

  24. Irwin RS, Boulet LP, Cloutier MM, et al. Managing cough as a defense mechanism and as a symptom. A consensus panel report of the American College of Chest Physicians. Chest. Aug 1998;114(2 Suppl Managing):133S-181S. [Medline].

  25. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. Mar 1 2001;344(9):665-71. [Medline].

  26. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. Feb 2000;154(2):150-4. [Medline].

  27. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. Jun 1997;151(6):569-72. [Medline].

  28. Nelson W, Behrman RE, Kliegman RM. Nelson Textbook of Pediatrics. 15th ed. Elsevier Science; 1996:1052-4.

  29. Sheikh S, Stephen T, Howell L, Eid N. Gastroesophageal reflux in infants with wheezing. Pediatr Pulmonol. Sep 1999;28(3):181-6. [Medline].

  30. Shepherd RW, Wren J, Evans S, et al. Gastroesophageal reflux in children. Clinical profile, course and outcome with active therapy in 126 cases. Clin Pediatr (Phila). Feb 1987;26(2):55-60. [Medline].

  31. [Guideline] Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):154S-168S. [Medline].

  32. Spitzer AR, Boyle JT, Tuchman DN, Fox WW. Awake apnea associated with gastroesophageal reflux: a specific clinical syndrome. J Pediatr. Feb 1984;104(2):200-5. [Medline].

  33. Strople J, Kaul A. Pediatric gastroesophageal reflux disease--current perspectives. Curr Opin Otolaryngol Head Neck Surg. Dec 2003;11(6):447-51. [Medline].

  34. Ward C, Forrest IA, Brownlee IA et al. Pepsin like activity in BAL is suggestive of gastric aspiration in lung allografts. Thorax. 2005;60:872-874.

  35. Young MA, Reynolds JC. Respiratory complications of gastrointestinal diseases. Gastroenterol Clin North Am. Dec 1998;27(4):721-46. [Medline].

 
Previous
Next
 
Chest radiograph of a child with a tracheostomy and recurrent aspiration reveals patchy infiltrates and increased interstitial markings.
Lateral chest radiograph of the same child as in the previous image reveals increased interstitial markings and patchy and perihilar infiltrates.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.