Oropharyngeal aspiration and oropharyngeal dysphagia in children: assessment, treatment and relationship with respiratory disease

Oropharyngeal aspiration (OPA), recurrent small volume aspiration of saliva, food and/or fluids, can lead to recurrent respiratory illness, chronic airway disease and recurrent hospitalisations in children. OPA is common in children who present with oropharyngeal dysphagia (feeding and swallowing difficulties) and neurological impairment, but may also be present in children with unexplained respiratory disease. Limited literature suggests that the type of food/fluid aspirated impacts on development of pneumonia and respiratory sequelae in children. Currently, there are little high quality published data about the prevalence and clinical presentation OPA, its impact on respiratory health, or optimal assessment and management of OPA in a very young paediatric population. This thesis addresses the current lack of published data and gap in knowledge on OPA and dysphagia in children and includes a series of studies investigating OPA using modified barium swallow study (MBS) in a population of children presenting with oropharyngeal dysphagia in a tertiarylevel hospital. The over-arching aim of the thesis is to improve clinical issues relevant to the detection and management of children with OPA and oropharyngeal dysphagia, particularly those pertinent to the respiratory system. The specific aims of the thesis were: 1. To determine prevalence of, and patient-factors associated with, OPA and silent aspiration in a cohort of children presenting with oropharyngeal dysphagia. 2. To identify the ‘best’ (highest Odds Ratio) clinical markers (signs and symptoms) associated with OPA and other forms of swallowing dysfunction, and to determine the influence of age and neurological impairment on these markers. 3. To document the extent and predictors of radiation doses received by children undergoing an MBS study. 4. To determine the association between OPA and other swallowing dysfunction with World Health Organisation (WHO)-defined pneumonia and respiratory disease. 5. To perform a systematic review using Cochrane methodology to evaluate the efficacy of restriction of oral intake of water for aspiration lung disease in the management of children with radiological evidence of OPA. 6. To examine the types of feeding/swallowing management recommendations given to families, following radiological evidence (via MBS) of OPA and other swallowing dysfunction.