Further Outpatient Care

See the list below:

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

Further Inpatient Care

See the list below:

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.

Inpatient & Outpatient Medications

See the list below:

See Medication.

Transfer

See the list below:

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

See the list below:

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

See the list below:

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

See the list below:

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

See the list below:

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.

Vandenplas Y and Rudolph C. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009. 49:498-547.
de Benedictis FM, Carnielli VP, de Benedictis D. Aspiration lung disease. Pediatr Clin North Am. 2009 Feb. 56(1):173-90, xi. [QxMD MEDLINE Link].
Callahan CW. Increased gastroesophageal reflux in infants: can history provide an explanation?. Acta Paediatr. 1998 Dec. 87(12):1219-23. [QxMD MEDLINE Link].
Callahan CW, Sisler C. Use of seating devices in infants too young to sit. Arch Pediatr Adolesc Med. 1997 Mar. 151(3):233-5. [QxMD MEDLINE Link].
Callahan CW. The diagnosis of gastroesophageal reflux in hospitalized infants: 1971-1995. J Am Osteopath Assoc. 1998 Jan. 98(1):32-4. [QxMD MEDLINE Link].
Orenstein D. Aspiration pneumonias and gastroesophageal reflux - related respiratory disease. In: Nelson Textbook of Pediatrics. 15th ed. Elsevier Science. 1996:1213-1215.
Orenstein SR. Gastroesophageal reflux. Pediatr Rev. 1999 Jan. 20(1):24-8. [QxMD MEDLINE Link].
Orenstein SR, Orenstein DM. Gastroesophageal reflux and respiratory disease in children. J Pediatr. 1988 Jun. 112(6):847-58. [QxMD MEDLINE Link].
Nelson SP, Chen EH, Syniar GM, Christoffel KK. One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatric Practice Research Group. Pediatrics. 1998 Dec. 102(6):E67. [QxMD MEDLINE Link].
Richter JE. Extraesophageal presentations of gastroesophageal reflux disease. Semin Gastrointest Dis. 1997 Apr. 8(2):75-89. [QxMD MEDLINE Link].
Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol. 2004 Jan. 113(1):11-28; quiz 29. [QxMD MEDLINE Link].
Sheikh S, Allen E, Shell R, Hruschak J, Iram D, Castile R, et al. Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants. Chest. 2001 Oct. 120(4):1190-5. [QxMD MEDLINE Link].
Gurberg J, Birnbaum R, Daniel S. Laryngeal penetration of videofluoroscopic swallowing study is associated with increased pneumonia in children. International Journal of Pediatric Otorhinolaryngology. 2015. 79:1827-1830.
Yoshikawa H, Yamazaki S, Abe T. Acute respiratory distress syndrome in children with severe motor and intellectual disabilities. Brain Dev. 2005 Sep. 27(6):395-9. [QxMD MEDLINE Link].
Kohda E, Hisazumi H, Hiramatsu K. Swallowing dysfunction and aspiration in neonates and infants. Acta Otolaryngol Suppl. 1994. 517:11-6. [QxMD MEDLINE Link].
Carre IJ. The natural history of the partial thoracic stomach (hiatus hernia) in children. Arch Dis Child. 1959 Aug. 34:344-53. [QxMD MEDLINE Link].
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.
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. 1993 Sep. 123(3):371-5. [QxMD MEDLINE Link].
Jancelewicz T, Lopez M, Downard C, et al. Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review. Journal of Pediatric Surgery. 2016.
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. 2003 Jun. 38(6):975-7. [QxMD MEDLINE Link].
Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseglia A, Strisciuglio P. Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey. Pediatrics. 2009 Mar. 123(3):779-83. [QxMD MEDLINE Link].
Chang AB. Cough: are children really different to adults?. Cough. 2005 Sep 20. 1:7. [QxMD MEDLINE Link].
Darrow DH, Harley CM. Evaluation of swallowing disorders in children. Otolaryngol Clin North Am. 1998 Jun. 31(3):405-18. [QxMD MEDLINE Link].
Derkay CS, Schechter GL. Anatomy and physiology of pediatric swallowing disorders. Otolaryngol Clin North Am. 1998 Jun. 31(3):397-404. [QxMD MEDLINE Link].
Goldsobel AB, Chipps BE. Cough in the pediatric population. J Pediatr. 2010 Mar. 156(3):352-8. [QxMD MEDLINE Link].
Harding SM, Richter JE. The role of gastroesophageal reflux in chronic cough and asthma. Chest. 1997 May. 111(5):1389-402. [QxMD MEDLINE Link].
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. 1998 Aug. 114(2 Suppl Managing):133S-181S. [QxMD MEDLINE Link].
Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1. 344(9):665-71. [QxMD MEDLINE Link].
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. 2000 Feb. 154(2):150-4. [QxMD MEDLINE Link].
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. 1997 Jun. 151(6):569-72. [QxMD MEDLINE Link].
Nelson W, Behrman RE, Kliegman RM. Nelson Textbook of Pediatrics. 15th ed. Elsevier Science; 1996. 1052-4.
Sheikh S, Stephen T, Howell L, Eid N. Gastroesophageal reflux in infants with wheezing. Pediatr Pulmonol. 1999 Sep. 28(3):181-6. [QxMD MEDLINE Link].
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). 1987 Feb. 26(2):55-60. [QxMD MEDLINE Link].
[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. 2006 Jan. 129(1 Suppl):154S-168S. [QxMD MEDLINE Link].
Spitzer AR, Boyle JT, Tuchman DN, Fox WW. Awake apnea associated with gastroesophageal reflux: a specific clinical syndrome. J Pediatr. 1984 Feb. 104(2):200-5. [QxMD MEDLINE Link].
Strople J, Kaul A. Pediatric gastroesophageal reflux disease--current perspectives. Curr Opin Otolaryngol Head Neck Surg. 2003 Dec. 11(6):447-51. [QxMD MEDLINE Link].
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.
Young MA, Reynolds JC. Respiratory complications of gastrointestinal diseases. Gastroenterol Clin North Am. 1998 Dec. 27(4):721-46. [QxMD MEDLINE Link].

Media Gallery

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.

of 2

Author

Cecilia P Mikita, MD, MPH 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

Disclosure: Nothing to disclose.

Coauthor(s)

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler 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, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Chief Editor

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

Acknowledgements

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.