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Original Research: PEDIATRICS |

Oropharyngeal Aspiration and Silent Aspiration in ChildrenOropharyngeal and Silent Aspiration in Children

Kelly A. Weir, MSpPath; Sandra McMahon, PhD; Simone Taylor, BN; Anne B. Chang, PhD
Author and Funding Information

From the Speech Pathology Department (Ms Weir), and the Department of Respiratory Medicine (Ms Taylor and Dr Chang), Royal Children’s Hospital, Brisbane, QLD; Queensland Children’s Medical Research Institute (Ms Weir and Dr Chang), University of Queensland, QLD; SpeechNet Speech Pathology Services (Dr McMahon), Queensland, QLD; and the Child Health Division (Dr Chang), Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.

Correspondence to: Kelly Weir, MSpPath, Speech Pathology Department, Level 4 Coles Health Services Bldg, Royal Children’s Hospital, Herston Rd, Herston, Brisbane, QLD, 4029, Australia; e-mail: k.weir1@uq.edu.au


For editorial comment see page 567

Funding/Support: This research was supported by the Royal Children’s Hospital Foundation, Brisbane, QLD, Australia [Grant 914-042]. Dr Chang was supported by a National Health & Medical Research Council Practitioner Fellowship [NHMRC Grant 545216].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):589-597. doi:10.1378/chest.10-1618
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Background:  Limited information exists about the nature of and factors associated with oropharyngeal aspiration (OPA) and silent aspiration (SA) in children. A prospective study was undertaken to determine the factors associated with fluoroscopically identified OPA and SA.

Methods:  Three hundred children presenting with feeding difficulties underwent a videofluoroscopic swallow study (VFSS) for evaluation of swallowing. Swallowing performance on each food and fluid consistency was rated using the penetration-aspiration scale, and children were classified into the following groups: OPA, SA, overt aspiration (OA), and no aspiration (NA).

Results:  OPA occurred in 34% of children; of these, 81% had SA. SA was significantly associated with neurologic impairment (OR, 4.65; 95% CI, 2.26-9.54), developmental delay (OR, 4.62; 95% CI, 2.28-9.35), aspiration lung disease (OR, 3.22; 95% CI, 1.29-8.05), and enteral feeding (OR, 2.03; 95% CI, 1.04-3.62). Similar results were found for OPA. Children with SA were more likely to have neurologic disease (OR, 4.1; 95% CI, 1.1-15.8) than those with OA. Age or gender differences, gastroesophageal reflux disease, recurrent respiratory tract infections, and asthma were no more likely to occur in children with OPA, SA, or OA.

Conclusions:  SA is very common in children with feeding difficulties and is most likely to occur in children with a neurologic problem. Limited medical diagnoses distinguished between aspirators (OPA, SA) and those with NA. VFSS should be performed in children with feeding difficulties and diagnoses of neurologic impairment, cerebral palsy, aspiration lung disease, and/or enteral feeding because of the increased likelihood of SA.


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