When food goes down the wrong pipe
By Ashleigh Townley, Rebecca Perlin and Joanne Downing
Mealtimes can be great opportunities for families to sit down together, socialize and even relax! But they can also be a time of concern—especially for parents of children with disabilities. For example, you might find yourself wondering if it’s safe to feed your child by mouth. This is a valid question. You may have discussed your concerns with your child’s medical team and they may have told you about aspiration.
So what is aspiration?
Aspiration is when food, liquid, saliva or vomit go down the wrong pipe. Instead of heading into the stomach, where they are supposed to go, they instead enter the breathing tube and end up in the lungs.
This can cause medical issues. For parents of children with physical or developmental disabilities, it can become an everyday concern because of long-term changes to the lungs. Left untreated,aspiration can lead to lung damage, which can make it harder for your child to breathe or recover from illnesses. For example, it can result in bacteria in the lungs and lead to pneumonia. If aspiration is caught early on, however, and with proper management, you can help to reduce the risk to your child’s lungs.
But my child doesn’t cough or choke when they are eating and drinking!
For typically developing children and adults, our bodies tell us right away when something has gone down the wrong pipe—we cough, hack and sputter to get it out. But in some cases, a child doesn’t cough or show any signs of distress when they are aspirating (not swallowing safely). This is called silent aspiration. This is not good, because there are no warning signs to tell parents that they need to seek help.
What can I do if I think my child is at risk of aspiration?
First and foremost, if you’re concerned that your child might be at risk of aspiration, speak to your child’s health care provider about next steps. This could be your speech–language pathologist, occupational therapist, doctor or dietitian. They may recommend a referral for an assessment in your community or to a specialized feeding and swallowing team.
Prevention is key to reducing the risk and effects of aspiration. Every child is different, and strategies should be tailored to your child’s specific needs in partnership with your clinician. Your child’s medical team may recommend:
• managing medical issues (e.g., reflux and constipation) because these can affect your child’s appetite;
• making the bites or sips bigger or smaller for your child so they can chew and swallow the food better;
• changing your child’s position during eating and drinking to match their age and ability (a clinician may recommend different types of seating to help your child do this);
• leaving more time between bites and sips to allow your child to finish what is in their mouth before giving the next bite or sip;
• changing the temperature or flavour of meals to make it easier for your child to feel the food or liquid in their mouth and throat;
• changing the consistency of the food or liquid for your child, making it thinner or thicker to help with their swallowing; or
• changing the texture of your child’s food, such as making it softer, smoother, less chunky or even crunchier!
For information on Holland Bloorview’s feeding and swallowing services, visit: www.hollandbloorview.ca/feedingservice or telephone 1-800-363-2440 ext. 3835.
Ashleigh Townley is a knowledge broker with Evidence to Care at Holland Bloorview Kids Rehabilitation Hospital, where she promotes and implements the best available research evidence to inform care for children with disabilities.
Rebecca Perlin, MClSC SLP(C) reg. CASLPO, is a speech–language pathologist at Holland Bloorview Kids Rehabilitation Hospital. She works with clients and families as part of the Feeding and Swallowing Clinic, the Cleft Lip and Palate Craniofacial Program, the Neuromuscular Team and Spina Bifida/Spinal Cord Team.
Joanne Downing is a family leader at Holland Bloorview Kids Rehabilitation Hospital. As a former client of the Feeding and Swallowing Clinic, Joanne has first-hand experience with aspiration.