Respiratory infections in children are common particularly in the first three years of life. They have a considerable impact on childhood health, account for most hospital admissions, affect quality of life, and are a sizeable economic burden to society because of health care use, parental work absenteeism, and secondary infections of parents and siblings. ¹
Children with Cerebral Palsy (CP) suffer from some degree of abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles. The degree of control varies among children. Obvious muscles affected are those large muscles of the arms and legs but muscles that control breathing, and swallowing, can also be affected.
Children with cerebral palsy in Long Island are vulnerable to respiratory infections because they tend to move less, breathe shallow and have weakened oral motor skills. It is not uncommon for any child with neuromuscular abnormalities to have underlying respiratory illnesses. 77% of the deaths of children with severe disabilities were caused by pneumonia, an infection of the lungs. ²
The most common cause of respiratory illness and pneumonia in children with CP is aspiration. Aspiration is when food, drink or saliva make their way into the lungs. Aspiration may be noticed when a child coughs or chokes, often during mealtimes but most of the time there are no outward signs of aspiration (silent aspiration). Bacteria in the aspirate that enters the lungs can cause respiratory illness or chronic inflammatory responses. This can lead to the development of frequent lung infections, wheezing, cough and pneumonia.
(1) Dysphagia-difficulty swallowing It is the inability of food or liquids to pass easily from a child’s mouth, into the throat, and through the esophagus to the stomach during the process of swallowing. This can also be drooling saliva (which is a marker of swallowing difficulties). Dysphagia may result in inadequate airway protection during swallowing. The child may not be able to manage food or liquid well or accept an age-appropriate diet.
(2) Uncontrolled seizures- Epilepsy is common in CP. During a seizure, a child may vomit, drool, or stop breathing. The vomit or excess saliva can be aspirated into the lungs. Seizure medications can sometimes cause sedation which leads to increased drooling and further aspiration.
(3) Gastro‐esophageal reflux– (when material from the stomach rises to the esophagus) from weakness or spasticity in the muscles of the digestive tract. Reflux may trigger cough and choking which may also cause breathing problems that can contribute to aspiration which in turn may lead to respiratory illnesses.
(4) Scoliosis– spinal curvature. Scoliosis is a deformity of the backbone (spine) identified as a side-to-side curve. Depending upon the severity of the curvature, this deformity an affect the ability of the lungs to expand and make breathing more difficult. As the child grows, the degree of curve can become greater and over time create more breathing problems. Children also tend to be less active as the curve increases.
A child with CP may experience one or all of the above conditions leading to a significant risk for frequent respiratory illnesses.
Treatment of respiratory illness, like prevention, involves a partnership between health professionals and children/families with CP. Management must be proactive and timely.
Assessment of respiratory health in children with CP is an ongoing process that continues for every child until the risk is mitigated. Medical follow up will assist in identification of both risk and presence of respiratory illness, inform planning for ongoing management of respiratory risk factors, support education and assist clear communication.
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