Deglutition and Respiration: Development, Coordination, and Practical Implications

Abstract

Temporal coordination of deglutition and respiration is essential for survival because both functions share the pharynx as a common pathway. Disruptions in this interface in young infants may result in dysphagia that may lead to aspiration and injury to the developing lung. Likewise, respiratory problems may contribute to the development of swallowing problems. This article focuses on the coordination between swallowing and breathing in infants and children, aspiration during periods of postnatal lung development and airway protective mechanisms. Identification of infants and children at increased risk for oropharyngeal dysphagia and respiratory disease is critical for optimal intervention. Assessment and management considerations are described.

Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children

“…While cough and wet voice (voice changes) were identified as important clinical markers in both studies, the current authors did not find gag to be significantly associated with OPA on either food/fluid consistency in the present cohort. Other clinical markers reported in the literature to be associated with OPA, such as wheeze, stridor, throat clearing, desaturations or apnoea during feeding, laboured breathing during feeding, or temperatures following oral intake [7,8,17], were also not found to be significantly associated with thin fluid aspiration in the current study. While the present authors did not find any clinical markers significantly associated with OPA on purées, DEMATTEO et al [7] reported that colour changes and abnormal respiration presented a nonsignificant relative risk of 3.0 for solid aspiration.…”

“…Apnoea was defined as a halt in respirations and facial colour change observed visually, with an accompanying oxygen desaturation ,90% Sp,O 2 requiring interruption of the feed at least once per feed for more than one feed, as noted by medical/nursing staff. Clinical markers were chosen from reported presentations of oropharyngeal dysphagia and aspiration from the literature [7,8,10,17].…”

“…Clinicians utilise a variety of symptoms and signs as indicators of OPA and swallowing dysfunction, including cough, wheeze, recurrent pneumonia, gagging, choking, congestion, tachypnoea, bradycardia, apnoea, cyanosis with feeds, oxygen desaturations, noisy or wet breathing, delayed swallows and voice changes [5][6][7][8][9]. In addition, signs such as gurgly respiration or wet voice can also be associated with hypopharyngeal or laryngeal pooling of secretions, or pharyngeal residue of food materials [5,10].…”

“…In addition, signs such as gurgly respiration or wet voice can also be associated with hypopharyngeal or laryngeal pooling of secretions, or pharyngeal residue of food materials [5,10]. Some authors suggest that airway responses to OPA are age dependent, with infants demonstrating a combination of apnoea, vocal cord constriction, rapid swallowing and bradycardia (laryngeal chemoreflexes) [11], while older children and adults typically demonstrate a cough response [8,12]. The clinical feeding evaluation and the use of clinical signs is known to have poor reliability in detecting aspiration compared with objective evaluation of swallowing during a VFSS, especially in neurologically impaired children, where the presence of silent aspiration or aspiration without an obvious cough or choking is likely [13].…”

Pediatric Dysphagia: Physiology, Assessment, and Management

“…However, the causes of dysphagia in pediatric populations are often somewhat different than in adult patients [5]. Table 3 summarizes common causes of dysphagia in pediatric patients [1,5,6,7,8,9,10,11,12,13]. …”