Author: Mercado-Deane, M, Burton, E., Harlow, S., Glover, A., Deane, D., Guill, M., & Hudson, V.
Source: Pediatric Radiology (2001), 31: 423-428.
The purpose of this study was to look at how many infants with breathing and vomiting symptoms had problems with swallowing. The study looked at 472 full term infants less than 1 year of age who were referred for an Upper GI test. The upper GI (UGI) is a moving x-ray of the whole digestive tract (the mouth, throat, food tube, stomach and intestines). In most UGI tests, swallowing is looked at very quickly and more time is spent looking at the digestive tract.
In this study, the babies? swallowing was looked at during the UGI test. Problems swallowing were defined as either tracheal aspiration (liquid going into the trachea or windpipe) or laryngeal penetration (liquid going into the windpipe but coming back out again).
The study looked at the babies who had vomiting and breathing problems but without other more complicated medical issues. Of these infants, 63 (13%) had swallowing problems: 44 had tracheal aspiration and 19 had laryngeal penetration. Once the swallowing problems were seen, the babies then had another test called a modified barium swallow study (MBSS) to look in more detail at the swallowing. In this study, the MBSS showed that all the babies who had problems during the Upper GI also had problems on the MBSS. During the MBSS, the doctor and therapist can look at the swallowing (in more detail) to see what the specific problem is and suggest the best way for the child to eat. By looking at swallowing ability more closely during an Upper GI test, swallowing problems may be identified that might be missed otherwise. Episodes of tracheal aspiration are sometimes quick and may not be seen if swallowing is not looked at carefully.
Swallowing problems can occur in healthy normal infants with the only sign being respiratory symptoms such as coughing, congestion, and infections. In this study, finding penetration on an UGI often indicated a more serious swallowing problem; out of 16 patients with penetration on the UGI, 6 had aspiration on a MBSS when looking more closely. Why a healthy normal infant would have a swallowing problem is not clear. The authors felt that possible reasons might be that the infant can not breathe well while eating, has not fully developed the neuromuscular control needed for swallowing, or might have a problem in the airway such as a floppy throat, tongue or palate or possibly have swelling in the voice box.
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