Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability

Lower respiratory tract infections in children with severe neurodisability are usually caused by aspiration of stomach contents from gastroesophageal reflux (GOR) or direct aspiration (DA) of food due to oral and pharyngeal m otor problems. To determine the contributions and interactions of GOR and D A, oesophageal 24-hour pH monitoring and feeding videofluoroscopy were perf ormed in 34 children (age range 7 months to 16 years, mean 7 years) who had severe physical and learning disabilities and who were slow feeders. Subje cts were divided into three groups according to the frequency of their resp iratory tract infections. Subjects in group 1 had no respiratory tract infe ctions (N=10); five had GOR and none had DA. Subjects in group 2 had minor respiratory tract infections but had not received more than one course of a ntibiotics for this in the previous year (N=8); two had GOR alone, four had DA alone, and two had neither. All subjects in group 3 had recurrent respi ratory tract infections (N=16); one had GOR alone, seven had DA alone, and eight had both GOR and DA. This study suggests that oral and pharyngeal mot or problems are the major cause of respiratory tract infection in children with severe neurodisability. These problems lead to DA and, if GOR is prese nt, to the aspiration of stomach contents. Those children with both DA and GOR are more likely to have severe respiratory tract infections which may l ead to gastrostomy feeding (together with fundoplication). GOR without suff icient oral and pharyngeal motor problems to cause DA is less likely to cau se respiratory tract infection in children with severe neurodisability.