Clinical Indicators of Aspiration in Children

RESEARCH QUESTION: We employed a retrospective study design to investigate how demographic data and feeding evaluation findings predicted aspiration in the pediatric setting. We hypothesized that information derived from this review could be used to devise a protocol for modified barium swallow study (MBSS) referral.

RATIONALE: Young children with complex medical needs often require MBSS to assess the safety of swallowing. One challenge that pediatric dysphagia therapists encounter is determining who needs MBSS in light of limited resources and unnecessary risk of radiation exposure. Knowing which bedside clinical indicators of aspiration best predict MBSS outcomes would aid in clinical decision making for MBSS recommendation.

DESIGN: Retrospective chart review

PARTICIPANTS: One hundred charts were reviewed retrospectively of patients ages 2 wk–18 yr who received both MBSS and feeding assessments at a large pediatric hospital.

METHOD: Concurrent feeding evaluations and MBSS studies were reviewed retrospectively for physiological and behavioral signs of aspiration.

ANALYSIS: We compared the findings on the feeding evaluation with the presence or absence of aspiration during the MBSS. Data were analyzed with Fisher’s exact methods to determine if relationships exist between demographic data and findings from feeding evaluation and MBSS results.

RESULTS: We reviewed the charts of 100 children who had feeding assessments and MBSS and compared demographic data and findings from clinical assessment with the results of the MBSS. Neurological diagnosis was a significant predictor of aspiration (.003), miscellaneous diagnosis was a predictor of nonaspiration (.005), and delayed swallow on clinical exam was a predictor of aspiration (.004). Results suggest that children with neurological diagnoses and children with a delayed swallow on clinical exam would benefit from an MBSS to rule out aspiration.

DISCUSSION: Neurological diagnoses predicted aspiration and miscellaneous diagnosis predicted nonaspiration. These findings support using diagnosis to help determine which children would benefit from an MBSS. The only significant clinical indicator was delayed swallow. Taken together, these findings can be used to develop guidelines to determine which children with feeding difficulties should be referred for further assessment using MBSS.

IMPACT STATEMENT: Knowing which clinical indicators of aspiration best predict MBSS outcomes would aid in clinical decision making for MBSS recommendation. Evaluating the efficacy of client-centered interventions achieves our goals in the Centennial Vision (American Occupational Therapy Association, 2007) by being science driven and competitive in the marketplace and providing evidence-based intervention to better serve societal needs.

References

American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. http://dx.doi.org/10.5014/ajot.61.6.613

DeMatteo, C., Matovich, D., & Hjartarson, A. (2005). Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Developmental Medicine and Child Neurology, 47, 149–157. http://dx.doi.org/10.1111/j.1469-8749.2005.tb01108.x

Richter, G. (2010). Management of oropharyngeal dysphagia in the neurologically intact and developmentally normal child. Current Opinion in Otolaryngology and Head Neck Surgery, 18, 554–563. http://dx.doi.org/10.1097/MOO.0b013e32834029de

Weir, K., McMahon, S., Barry, L., & Chang, A. B. (2009). Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children. European Respiratory Journal, 33, 604–611. http://dx.doi.org/10.1183/09031936.00090308