Aerodigestive problems and management in children with neuromuscular disorders

Aerodigestive concerns are common in children with neuromuscular disorders and can emanate from upper or lower gastrointestinal tract pathology. Dysphagia can occur at any step of the intricately coordinated swallowing process due to muscle weakness and/or altered neural mechanisms resulting in aspiration. The clinical presentation can be silent, requiring an astute clinician to maintain a high index of suspicion. Multiple modalities exist to diagnose dysphagia and aspiration, from a clinical exam with speech language pathologists to video fluoroscopic swallow study. More invasive tests are flexible bronchoscopy with bronchoalveolar lavage or fiberoptic endoscopic evaluation of swallow. The source of aspirate will guide treatment. The treatment ranges from adjusting the nutritive regimen or route to medications for sialorrhea or gastroesophageal reflux. The surgical management for sialorrhea and gastroesophageal reflux can also be considered. As for the lower GI tract, constipation is common in neuromuscular disorders and requires aggressive treatment.