Aspiration in the Child with Cerebral Palsy

Abstract

Patients with cerebral palsy are at significant risk for aspiration, which leads to lung injury, chronic inflammation, and eventual increased morbidity and mortality. Aspiration, the penetration of the airway by inhaled foreign material, results from poor protection of the upper airway, either through penetration of the larynx or through the reflux of gastroesophageal contents causing airway irritation. This commonly occurs through ineffective clearance of secretions in the upper airway, oropharyngeal dysphagia, or gastroesophageal reflux. The result is aspiration pneumonitis, chemical injury to the airway or aspiration pneumonia, focal bacterial infection, tracheobronchitis, and chronic inflammation. Imaging is nonspecific and testing is not always confirmatory of a diagnosis. Treatment can include various medical therapies for the improved control of secretions and the management of reflux and can extend to surgical interventions. Ultimately, a multidisciplinary approach to management and control of aspiration can reduce morbidity and mortality in this population.