Clinical signs of aspiration may include coughing, choking, gagging, inability to handle oral secretions, wet upper airway sounds with poor vocal quality, apnea, food refusal, frequent upper respiratory infections, and aspiration pneumonia. Aspiration of food may occur without physical evidence if the protective cough or gag is not functioning, sensory deficits exist, and/or the swallowing mechanism is dysfunctional. This results in what is termed silent aspiration. Although aspiration from solid food can be detected, the possibility of aspiration from gas-troesophageal reflux (GER) may also need to be considered. The regurgitation of gastric contents from the stomach into the esophagus can lead to irritability during or after feeding, arching, esopha-gitis, and ultimately food refusal. Other symptoms of GER include respiratory compromise, apnea, and drooling. Treatment for GER includes the use of antacids, H2 blockers, medications to increase gut motility, reduction in feeding rate, positioning, thickening of foods or liquids, or surgical intervention. Small, frequent feedings help to decrease the volume in the stomach at one time.
Fatigue may occur in the child who is not able to sustain the work involved with feeding and may be expressed by an increase in respiratory rate, diaphoresis, or increased work of breathing. The causes may be muscular, respiratory, or cardiac, and they may increase the risk of aspiration or hypoxia. The work required to eat a meal is accomplished at a higher physiological cost to the child, thereby increasing caloric needs.
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