Feature Article

Aspiration among Consumers with Developmental Disabilities

Aspiration is a type of swallowing problem. It has to do with things such as food, drink, medication, spit, or vomit getting into your lungs. These things can get into your lungs by "going down the wrong pipe." In the back of your mouth, there are two openings. One opening goes to the esophagus (sometimes called the "food pipe") - this leads to your stomach. The other opening goes to the trachea (sometimes called the "wind pipe") - the trachea leads to your lungs. When you take a breath, the air flows down your trachea to fill up your lungs. When you swallow, whatever you have in your mouth goes down your esophagus to your stomach. Aspiration is when anything except air (food, liquid, medication, saliva, vomit) goes into your trachea or into your lungs.

Aspiration can happen to anybody, but it happens more often to children, elderly people, and people with some types of developmental disabilities or neurological problems. Swallowing problems and aspiration are more likely to happen to people with:

  • Cerebral palsy
  • Epileptic seizures
  • Stroke
  • Multiple sclerosis
  • Parkinson's Disease
  • Poor or underdeveloped motor skills that do not allow adequate chewing or swallowing
  • Frequent vomiting
  • Poor eating skills (such as food stuffing or rapid eating)
  • Impaired ability to move that may leave a person unable to properly position him/herself for adequate swallowing
  • Long term use of nasogastric feeding tubes
  • A tracheostomy (a tube through the neck into the trachea ("windpipe") to help with breathing)
  • A history of choking or gagging on food

A person may become seriously ill before aspiration is recognized as a problem. So, it is important for families, consumers, and caregivers to keep a look out for the common signs and symptoms of swallowing problems and aspiration:

  • Coughing or gagging during or after meals
  • Drooling, or having food or fluid leak out of the nose
  • Wheezing
  • Gurgling sounds from throat or lungs
  • Breathing difficulty or noisy breathing
  • Having food left over in the mouth after swallowing
  • Feeling pain when swallowing
  • Having to make unusual head movements of the head or neck when swallowing

If you are concerned that you or somebody you care for may be having trouble swallowing, it is important that you talk to your doctor about the risks and about what can be done to stay safe. If care is not taken, aspiration can lead to serious illness or even death.

Swallowing problems and aspiration can result in malnutrition and weight loss. Another serious illness that swallowing problems can lead to is aspiration pneumonia. Aspiration pneumonia is caused by aspiration. Sometimes when vomit, food, drink, or saliva gets into the lungs, the lungs can start to swell and fill up with fluid. This can make a person very sick or even kill them. Aspiration pneumonia can get worse very quickly so it is important to go to the doctor if you think you or somebody you care for may have aspiration pneumonia. Signs and symptoms of aspiration pneumonia include:

  • Frequent coughing that brings up bad-smelling mucus from the lungs
  • Shortness of breath or noisy breathing
  • Fast heartbeat
  • Fever or chills
  • Chest pain when coughing or taking a deep breath
  • Trouble swallowing
  • Feeling like one cannot get enough air

If you or somebody you care about has trouble swallowing, there are things you can do to protect this person from getting ill. Some things you can do to prevent aspiration or its most serious effects are:

  • Have trained staff assist with eating
  • Offer more frequent, but smaller meals
  • Slow the pace of eating and decrease the size of bites
  • Eat while sitting up
  • Avoid use of beverages to wash food down
  • Avoid use of straws
  • Avoid lying down after meals
  • Avoid food and drink before bedtime

It is also important to have staff nearby who are trained in what to do when a consumer gets something caught in his/her throat. A doctor can give more recommendations on what to do to avoid aspiration.

Sources for this article include:

  • Oregon Department of Human Services: Resources for Seniors and People with Disabilities (http://www.oregon.gov/DHS/spd/provtools/dd/nursing_manual/aspiration.shtml)
  • Developmental Disabilities Digest (http://www.ddhealthinfo.org/ggrc/doc2.asp?ParentID=3195)
  • Health Touch Online (http://www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?fname=07190&title=ASPIRATION+PNEUMONIA+&cid=HTHLTH)

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