Restriction of oral intake of water for aspiration lung disease in children

University of Queensland, Paediatrics and Child Health, Herston, Queensland, Australia.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2005; 9(4):CD005303. DOI: 10.1002/14651858.CD005303.pub2
Source: PubMed


Primary aspiration of food and fluid can cause serious lung consequences in infants and children. Treatment recommendations for children who have primary aspiration of thin fluids includes restriction of thin fluids and provision of thickened fluids. Children often refuse to drink thickened fluids presenting a challenge for families to ensure that the child takes sufficient fluid. Allowing children who have thin fluid aspiration to drink water may assist in providing enough fluid without endangering the lung . This review found no evidence about drinking water in children with primary aspiration of thin fluids.

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    • "The hypothesis that aspiration and pneumonia are directly correlated has not been supported by the literature in several studies making it important that we question traditional treatment plans. (Weir et al, 2005) A holistic view of the child and the intervention for the aspiration need to be taken into consideration. "
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    ABSTRACT: 2012 Clinical Nutrition Week Focused Learning Session Aspiration during swallowing was long thought to have a direct causal link with aspiration pneumonia and chronic lung disease. In fact, most teaching programs for a variety of disciplines teach this as a fact. Unfortunately, accepting the causal link between aspiration and lower respiratory tract infections, may lead to feeding treatment plans that are disproportionate to the problem and do not consider the holistic care of the affected child and family. Let us consider what is known about aspiration and its consequences in children. Who aspirates? Children with neurodevelopmental problems, preterm infants, children with anatomic abnormalities of their aerodigestive tracts are all at increased risk of aspiration. The typical picture of a child who aspirates is one with a host of medical problems who has a neurodevelopmental problem like cerebral palsy who has difficulty both with food processing, as well as swallowing. Children with milder impairments, such as, Down Syndrome and Fetal Alcohol Syndrome also are more prone to aspiration. Aspiration during swallowing can be seen in children with typical development (Skeikh et al 2001). In addition, a clustering of cases in typical children with indigenous heritage has been described but is not yet fully understood (Rempel et al 2011) What about the causal relationship of aspiration and pneumonia? Several authors have looked at children who aspirate and the relationship with pneumonia. Weir et al (2007) suggested in her review of children with aspiration during swallowing that a fluoroscopic swallowing study might over-estimate the impact of aspiration in relation to other known factors that are associated with pneumonia. In this group of children, aspiration and pneumonia were not related when they controlled for other factors that could contribute to pneumonia: the factors of importance for development of pneumonia were history of lower respiratory tract infection, cough, mechanical ventilation, oxygen requirement, asthma, Down Syndrome and gastroesophageal reflux. Similarly, Rempel et al 2011 demonstrated that children who demonstrated aspiration during swallowing more likely to have pneumonia only if they had other risk factors for pneumonia. Langmore et al (1998) had a similar finding in adult patients who developed aspiration pneumonia: independent factors correlated with aspiration pneumonia included dependent for feeding, dental caries, smoking and multiple medical diagnoses.
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    ABSTRACT: The term aspiration lung disease describes several clinical syndromes, with massive aspiration and chronic lung aspiration being at two extremes of the clinical spectrum. Over the years, significant advances have been made in understanding the mechanisms underlying dysphagia, gastroesophageal function, and airway protective reflexes and new diagnostic techniques have been introduced. Despite this, characterizing the presence or absence of aspiration, and under what circumstances a child might be aspirating what, is extremely challenging. Many children are still not adequately diagnosed or treated for aspiration until permanent lung damage has occurred. A multidisciplinary approach is mandatory for a correct diagnosis in addition to timely and appropriate care.
    Full-text · Article · Mar 2009 · Pediatric Clinics of North America
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    ABSTRACT: Aspiration syndromes facilitate the colonization of the lower airways with bacterial pathogens and predispose to recurrent chest infections, chronic suppurative lung disease and bronchiectasis. In recent years important steps forward have been made in the understanding of the physiology of swallowing, the mechanisms underlying gastro-oesophageal reflux and the upper respiratory protective mechanisms for preventing aspiration. The diagnosis of aspiration however, and especially the establishment of a causal association with respiratory symptoms, remains challenging. Aspiration occurs sporadically and intermittently, and its manifestations are non-specific. There is no laboratory test that can establish with certainty whether or not aspiration lung disease is present; the diagnostic approach therefore remains primarily clinical, and laboratory investigations can only strengthen or weaken a clinical suspicion.
    Full-text · Article · Jul 2011 · Pneumon
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