Children's Hospital Colorado


Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

Help Me Decide

What is aspiration?

Aspiration happens when anything, such as food or liquid, is inhaled into the lungs. People sometimes describe aspiration as something "going down the wrong pipe." While everyone aspirates from time to time, most people are able to cough well enough to clear their airways. However, if someone aspirates frequently or is not able to cough sufficiently, it can lead to respiratory problems, like pneumonia.

Aspiration is a common problem in children that is usually first observed when the child chokes or has a chronic cough, and is often followed by other respiratory symptoms.

What causes aspiration?

There are many possible causes of chronic aspiration in children. The most frequent is gastroesophageal reflux disease (GERD), or acid reflux. Reflux is common in children, especially premature infants, and usually resolves as children age without causing aspiration.

Other causes of aspiration include swallowing dysfunction, anatomical disorders such as an abnormal connection between the air tube and food tube (fistula or cleft), and neurological disorders such as cerebral palsy. When swallowing dysfunction is present with GERD, aspiration and respiratory symptoms are more likely to occur. The amount of reflux material may also be significant and cause acute or persistent respiratory symptoms. Aspiration with symptoms requires a complete evaluation by a specialized team.

Who aspirates?

While everyone aspirates occasionally, chronic aspiration can often be found in children with other health problems, including:

  • Prematurity
  • Gastroesophageal reflux disease (GERD)
  • Anatomic defects
  • Chronic heart disease
  • Congenital syndromes

What are the signs and symptoms of aspiration?

  • Coughing or choking while eating
  • Vomiting while choking
  • Disrupted breathing while eating
  • Failure to thrive/difficulty gaining weight
  • Excessive drooling
  • Behavioral feeding problems
  • Chronic cough
  • Hoarseness
  • High-pitched wheezing on breathing in (stridor)
  • Chronic respiratory illness (such as recurrent pneumonia)
  • Air tube injury (bronchiectasis)

While all of the above symptoms are common with aspiration, it is possible for children to aspirate without displaying any symptoms.

What tests are used to diagnose aspiration?

A range of tests may be used to diagnose aspiration, including a swallow study and flexible and rigid bronchoscopy. A modified barium swallow study uses X-rays to make a video of your child eating and drinking various foods and liquids. This allows providers to examine the anatomy in your child's mouth and throat as well as his or her swallowing technique. The child is awake during the swallow study.

A flexible bronchoscopy is a procedure that allows pulmonary specialists to see your child's respiratory system. This is done by inserting a tiny video camera attached to a small flexible tube into your child's airways. Providers will be able to see any structural abnormalities that may contribute to aspiration; in some cases providers may be able to see evidence of aspiration in the airways.

A rigid bronchoscopy is a procedure completed by an ENT specialist to check the size of the airway and make sure there is no abnormal connection with the food tube.

How do providers at Children's Hospital Colorado make a diagnosis?

First, our doctors take a complete patient history, including information about your child's birth, such as gestational age and weight at birth. Providers will also ask about your child's growth pattern, feeding history and breathing problems. They may ask specific questions about problems that occurred during feeding transitions, for example, transitioning to using a spoon, cup or baby food.

They will also look at your child's current feeding schedule, typical foods and any symptoms that occur while eating.

Our healthcare providers will do a physical exam, focused on the head, neck, respiratory and gastrointestinal systems. They may perform a series of tests including a swallow study, a specialized test to look for reflux and/or a bronchoscopy. The exact method of making a diagnosis will depend on the underlying problem causing your child's aspiration.

How is aspiration treated?

Your doctor may prescribe medication to reduce GERD. He or she may also recommend that your child see a speech or occupational therapist to learn proper swallowing techniques. The treatment for aspiration is determined by what is causing it. Often, it can be treated by adjusting your child's feeding schedule or the foods he or she eats.

If there is an abnormal connection between your child's airway and esophagus, surgery may be needed. If these treatment options are not successful, other medical or surgical treatment options may be explored.

Why choose Children's Colorado for your child's aspiration?

The Aerodigestive Program at Children's Colorado is dedicated to providing comprehensive, state-of-the-art treatment and services for children with complex airway, respiratory and gastrointestinal tract disorders. It is the only multidisciplinary program of its kind in the region. The team is dedicated to the comprehensive care of children with complex airway and digestive tract disorders. We treat only children all day, everyday – making us experts when it comes to caring for kids.

Our patients' families are considered an essential element of the healthcare team and are encouraged to participate in planning their child's treatment course. This family-centered care approach allows for greater efficiency in scheduling visits and procedures. In addition, family-centered care provides the opportunity for improved patient and family education, which can help improve the overall patient experience and outcome.

In addition to the services our dedicated Aerodigestive Program team offers, we partner with other departments in the hospital to ensure your child is receiving the best, well-rounded care. When you bring your child to us for a visit, you can expect the following:

  • A comprehensive same-day visit with the Breathing Institute, ENT and Digestive Institute, as well as the Feeding and Swallowing team
  • Excellent patient and family education
  • Condensed evaluations and limited sedation for procedures
  • Coordinated communication with your primary care physician
  • A focus on quality outcomes for patients with complex health problems