1343 Unsafe Swallow in Children: Are we Doing Enough?

Abstract

Background: Recurrent chest infections are acommon problem in children with unsafe swallow. Tracheostomy and gastrostomy are commonlyperformed in such children. However, it is not clearwhether these interventions will resolve the problem.

Aim: Report the clinical profile of patients withunsafe swallow who have undergone tracheostomyand gastrostomy.

Methods: We retrospectively analysed childrenadmitted to Paediatric Critical Care Unit in atertiary referral hospital (March 2009-March 2010). We reviewed the indications for tracheostomy, associated co-morbidities, feeding adjuncts used, safety of swallow and the incidence of recurrentchest infections.

Results: Ten children were managed during thisperiod with a median age at tracheostomy was8 months (Range 1 week to 15 years). Commonindications for tracheostomy included failed /difficult intubation (2), bilateral vocal cord paralysis (1), failed extubation and prolonged ventilation requirement(4), airway protection following trauma(2) and cystic hygroma(1). Associated co-morbidities were Chronic Lung disease(3), Congenital Myasthenic syndrome(1), Cystic hygroma(1), hypoventilation syndrome(1), Cerebral and Renal Haemolytic Uraemic syndrome(1), Road Traffic accident with multiple organ injury(2). Out of 10, six children had unsafe swallow. Recurrent aspiration pneumonia remained a major problem despite these interventions.

Conclusions: Interventions such as tracheostomy and gastrostomy may not resolve the issues with recurrent chest infections in children with unsafe swallow. There is a need to explore other interventions to reduce recurrent aspiration pneumonitis in such population.

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