Dual aspiration sources – CP — RACP Paediatrics MCQ

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HardRespiratoryDual aspiration sources – CPRACP Paediatrics

The same child's management includes thickening of all fluids and upright positioning during feeds, but respiratory infections continue. Gastric contents are found in tracheal aspirate during bronchoscopy. What is the additional source of aspiration?

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Correct answer: A — Chronic aspiration

Tracheal aspirate containing gastric contents (positive for pepsin or lipid-laden macrophages) despite oral aspiration precautions indicates ongoing aspiration from gastro-oesophageal reflux. Chronic aspiration in neurologically impaired children often has dual sources: oropharyngeal (from above) and gastro-oesophageal (from below). Anti-reflux surgery (fundoplication) may need consideration alongside feeding modification.

Reference: RCH Melbourne – 2023 – Aspiration CPG; RACP Paediatric Curriculum – GI/Respiratory