Nelson Textbook of Pediatrics 22nd Edition | Persistent microaspiration due to swallowing dysfunction (oropharyngeal incoordination), GERD, anatomic abnormalities (laryngeal cleft, tracheoesophageal fistula), neurologic impairment. Clinical: chronic cough, wheezing, recurrent pneumonia, failure to thrive, feeding difficulties. Diagnosis: videofluoroscopic swallow study (VFSS) – gold standard, fiberoptic endoscopic evaluation of swallowing (FEES), salivagram, bronchoalveolar lavage (lipid-laden macrophages >10%). Management: thickened feeds, positioning, gastrostomy tube, fundoplication, treatment of GERD, tracheostomy for severe cases, anticholinergics for secretions.
🌐 paeds.online — Pakistan's Pediatric Platform| Condition | Diagnostic Test | Treatment |
|---|---|---|
| Oropharyngeal dysphagia | Videofluoroscopic swallow study (VFSS) – gold standard | Thickened feeds, feeding therapy, gastrostomy tube if severe |
| GERD-related aspiration | Esophageal pH/impedance, esophagogastroduodenoscopy | PPI/H2 blockers, prokinetics, fundoplication if refractory |
| Tracheoesophageal fistula / laryngeal cleft | Bronchoscopy, esophagography | Surgical repair |
| Neurologic impairment | VFSS, FEES | Gastrostomy (G-tube) or gastrojejunal (GJ-tube), fundoplication, manage secretions (glycopyrrolate) |