Aspiration

Health

Aspiration

Aspiration occurs when food, liquid, or other foreign substances enter the airway or lungs instead of the stomach. This can happen during swallowing and may lead to choking, respiratory problems or cardiac arrest.

Why Is This Important for People with ID/DD?

Aspiration is a significant concern for individuals with intellectual and developmental disabilities because they may have difficulty with swallowing, controlling head and neck muscles, or maintaining proper posture during meals. If food or liquid enters the lungs, it can cause serious health complications, such as pneumonia or choking, which can be life-threatening. Common factors for ID/DD individuals that increase the risk include mobility limitations, anatomical variations, (small airway, large tongue common in Down Syndrome), eating too quickly, inadequate chewing due to dental caries, or improper positioning when feeding.

PREVENTION

  • Treat underlying conditions: Manage issues such as esophageal spasms, often caused by severe acid reflux, to reduce aspiration risk.
  • Swallow study and assessments: A swallow study conducted by a licensed speech therapist or ENT can help assess aspiration risk. Occupational therapy assessments can identify adaptive equipment that can make eating safer.
  • Modified diets: A speech therapist, nutritionist, or physician may recommend a modified diet, such as mechanically soft or pureed foods, for individuals at high risk of aspiration. This may also include using thickeners for beverages.
  • Proper positioning: Sit upright (preferably at 90 degrees), minimize slouching, and feet should be supported or on the floor.  Instruct the person to slightly tuck their chin toward their chest when eating or drinking. This helps close the airway and redirects food and liquids to the esophagus, preventing aspiration into the airway.
  • Routine dental care: Address dental issues to ensure proper chewing and minimize discomfort.
  • Speech therapy: Therapy may improve control over the tongue and throat muscles, making swallowing safer.
  • Evaluate medications: Certain medications like sedatives, opioids, or muscle relaxers can impair swallowing, so careful consideration is needed.
  • Behavioral interventions: Encourage slower eating, smaller bites as well as increased swallowing between bites.
  • Severe cases: In extreme situations, individuals may need more significant medical interventions, including surgery, oral suctioning, or a feeding tube.

Helpful to Know

  • Common Signs/Symptoms of Aspiration: shortness of breath, sensation of something stuck in the throat, sudden coughing, wheezing, or hoarseness, drooling, changes in breathing patterns, regular coughing during meals, gurgling sounds or a change in voice after eating, excessive throat clearing.
  • Guidelines for Preventing Choking or Aspiration: The Office for People with Developmental Disabilities (OPWDD) has developed guidelines to prevent choking or aspiration. These guidelines assist in the safe preparation of food and liquid consistencies, based on recommendations from a healthcare provider following a swallowing study. For more information please visit: OPWDD Choking Prevention Initiative and/or OPWDD Annual Training.
  • OPWDD: Health and Safety Alert: Aspiration
  • Avoid Aspiration and Choking: Safe Swallowing Tips