[Dysphagia] "Aspiration tolerance"

[Jcarved at aol.com (Jcarved at aol.com)]

In a message dated 1/13/2007 10:18:39 PM Central Standard Time, 
vstefans at george.ach.uams.edu writes:


> I don't know how much data there is

We are collecting data in infants and young children at Children's Hospital 
of Wisconsin/Medical College - have presented preliminry data, but not 
published yet. When I say "we", this means physicians to include pulmonologists, 
gastroenterologists, and otolaryngologists for some as well as dietitians along 
with SLPs, etc.). We have been tracking now I think 12-15 patients from infants 
to some up to 18 months follow-up at this point. We are using a "dysphagia 
protocol" CT scan of chest with radiologists involved in establishing that 
protocol with our other physicians as baseline pulmonary objective data (obviously 
along with entire history and current pulmonary status) with normal findings on 
CT scan of chest and intermittent trace to minimal aspiration. Those meeting 
criteria have been (are) allowed to continue PO, not likely thickening either - 
with close clinical follow-up through our Feeding, Swallowing and Nutrition 
Center - not just pulmonary and feeding, but overall neurodevelopmental status, 
etc.  I can't go into all the details, but hopefully I have given enough to 
give you some idea of our tracking. So far all but 1 have continued to do well, 
repeat CT scan normal (not repeating often) and improved swallowing on VFSS - 
some we waited a year to retest if they were healthy, making developmental 
and feeding gains.... The one who was not kept totally PO ended up with a 
progressive severe neurologic diagnosis. We are not sure that the chest CT scan is 
the best measure, but for now that is what it is.

Clearly the big unanswered question continues to be - how much of what for 
how long can be aspirated and tolerated by an individual before chronic lung 
disease becomes problematic? We know that the rate of alveoli production is on a 
fairly steep curve during the first year and into the second year of life 
before it tapers off, and for some infants that young children that may be part of 
what helps as they reduce the aspiration with oral feeding over time.

The issues and questions are greater than can be handled via these kinds of 
messages, but a few comments..............

Thank you Vicky for emphasizing the concerns in the pediatric population.

joan arvedson


Joan C. Arvedson, PhD, CCC-SLP, BC-NCD, BRS-S, ASHA Fellow
Board Recognized Specialist in Swallowing and Swallowing Disorders
Program Coordinator, Feeding and Swallowing Services
Children's Hospital of Wisconsin-Milwaukee
PO Box 1997, Mail Station 785
Milwaukee, WI  53201

Clinical Professor, Dept. of Pediatrics
Medical College of Wisconsin-Milwaukee

Telephone: 414-266-6548

FAX: 414-266-6189