Aspiration Precautions

Aspiration pneumonia is an infection in the lungs. It occurs when saliva or liquid contaminated with bacteria is inhaled (aspirated) into the lungs. When these things get into the lungs, swelling (inflammation) and infection can occur.

This can make it difficult to breathe. Aspiration pneumonia is a serious condition and can be life threatening.

What are the causes?

This condition is caused when saliva or liquid from the mouth, throat, or stomach is inhaled into the lungs, and when those fluids are contaminated with bacteria.

What increases the risk?

The following factors may make you more likely to develop this condition:

• A narrowing of the tube that carries food to the stomach (esophageal narrowing).
• Having gastroesophageal reflux disease (GERD).
• Having a weak immune system.
• Having diabetes.
• Having poor oral hygiene.
• Being malnourished.

The condition is more likely to occur when a person’s cough (gag) reflex, or ability to swallow, has decreased. Some things that can cause this decrease include:

• Having a brain injury or disease, such as stroke, seizures, Parkinson disease, dementia, or amyotrophic lateral sclerosis (ALS).
• Being given a general anesthetic for procedures.
• Drinking too much alcohol. If a person passes out and vomits, vomit can be inhaled into the lungs.
• Taking certain medicines, such as tranquilizers or sedatives.

What are the signs or symptoms?

Symptoms of this condition include:

• Fever.
• A cough with secretions that are yellow, tan, or green.
• Breathing problems, such as wheezing or shortness of breath.
• Chest pain.
• Being more tired than usual (fatigue).
• Having a history of coughing while eating or drinking.
• Bad breath.
• Bluish color to the lips, skin, or fingers.

How is this diagnosed?

This condition may be diagnosed based on:

• A physical exam.
• Tests, such as:
  • Chest X-ray.
  • Sputum culture. Saliva and mucus (sputum) are collected from the lungs or the tubes that carry air to the lungs (bronchi). The sputum is then tested for bacteria.
  • Oximetry. A sensor or clip is placed on areas such as a finger, earlobe, or toe to measure the oxygen level in your blood.
  • Blood tests.
  • Swallowing study. This test looks at how food is swallowed and whether it goes into your breathing tube (trachea) or esophagus.
  • Bronchoscopy. This test uses a flexible tube (bronchoscope) to see inside the lungs.

How is this treated?

This condition may be treated with:

• Medicines. Antibiotic medicine will be given to kill the pneumonia bacteria. Other medicines may also be used to reduce fever or pain.
• Breathing assistance and oxygen therapy. Depending on how well you are breathing, you may need to be given oxygen, or you may need breathing support from a breathing machine (ventilator).
• Thoracentesis. This is a procedure to remove fluid that has built up in the space between the linings of the chest wall and the lungs.
• Feeding tube and diet change. For people who have difficulty swallowing, a feeding tube might be placed in the stomach, or they may be asked to avoid certain food textures or liquids when eating.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
  • Take cough medicine only if you are losing sleep. Cough medicine can prevent your body’s natural ability to remove mucus from your lungs.

General instructions

• Carefully follow any eating instructions you were given, such as avoiding certain food textures or thickening your liquids. Thickening liquids reduces the risk of developing aspiration pneumonia again.
• Use breathing exercises such as postural drainage, deep breathing, and incentive spirometry to help expel secretions.
• Rest as instructed by your health care provider.
• Sleep in a semi-upright position at night. Try to sleep in a reclining chair, or place a few pillows under your head.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have a worsening cough with yellow, tan, or green secretions.
• You have coughing while eating or drinking.

Get help right away if:

• You have worsening shortness of breath, wheezing, or difficulty breathing.
• You have chest pain.

Summary

• Aspiration pneumonia is an infection in the lungs. It is caused when saliva or liquid from the mouth, throat, or stomach is inhaled into the lungs.
• Aspiration pneumonia is more likely to occur when a person’s cough reflex or ability to swallow has decreased.
• Symptoms of aspiration pneumonia include coughing, breathing problems, fever, and chest pain.
• Aspiration pneumonia may be treated with antibiotic medicine, other medicines to reduce pain or fever, and breathing assistance or oxygen therapy.

Aspiration Precautions, Adult

Aspiration is the breathing in (inhalation) of a liquid or object into the lungs. Things that can be inhaled into the lungs include:

• Food.
• Any type of liquid, such as drinks or saliva.
• Stomach contents, such as vomit or stomach acid.

What are the signs of aspiration?

Signs of aspiration include:

• Coughing after swallowing food or liquids.
• Clearing the throat often while eating.
• Trouble breathing. This may include:
  • Breathing quickly.
  • Breathing very slowly.
  • Loud breathing.
  • Rumbling sounds from the lungs while breathing.
• Coughing up phlegm (sputum) that:
  • Is yellow, tan, or green.
  • Has pieces of food in it.
  • Is bad-smelling.
• Having a hoarse, barky cough.
• Not being able to speak.
• A hoarse voice.
• Drooling while eating.
• A feeling of fullness in the throat or a feeling that something is stuck in the throat.
• Choking often.
• Having a runny noise while eating.
• Coughing when lying down or having to sit up quickly after lying down.
• A change in skin color. The skin may look red or blue.
• Fever.
• Watery eyes.
• Pain in the chest or back.
• A pained look on the face.

What are the complications of aspiration?

Complications of aspiration include:

• Losing weight because the person is not absorbing needed nutrients.
• Loss of enjoyment and the social benefits of eating.
• Choking.
• Lung irritation, if someone aspirates acidic food or drinks.
• Lung infection (pneumonia).
• Collection of infected liquid (pus) in the lungs (lung abscess).

In serious cases, death can occur.

What can I do to prevent aspiration?

Caring for someone who has a feeding tube

If you are caring for someone who has a feeding tube who cannot eat or drink safely through his or her mouth:

• Keep the person in an upright position as much as possible.
• Do not lay the person flat if he or she is getting continuous feedings. If you need to lay the person flat for any reason, turn the feeding pump off.
• Check feeding tube residuals as told by your health care provider. Ask your health care provider what residual amount is too high.

Caring for someone who can eat and drink safely by mouth

If you are caring for someone who can eat and drink safely through his or her mouth:

• Have the person sit in an upright position when eating food or drinking fluids. This can be done in two ways:
  • Have the person sit up in a chair.
  • If sitting in a chair is not possible, position the person in bed so he or she is upright.
• Remind the person to eat slowly and chew well. Make sure the person is awake and alert while eating.
• Do notdistract the person. This is especially important for people with thinking or memory (cognitive) problems.
• Allow foods to cool. Hot foods may be more difficult to swallow.
• Provide small meals more frequently, instead of 3 large meals. This may reduce fatigue during eating.
• Check the person’s mouth thoroughly for leftover food after eating.
• Keep the person sitting upright for 30–45 minutes after eating.
• Do notserve food or drink during 2 hours or more before bedtime.

General instructions

Follow these general guidelines to prevent aspiration in someone who can eat and drink safely by mouth:

• Neverput food or liquids in the mouth of a person who is not fully alert.
• Feed small amounts of food. Do not force feed.
• For a person who is on a diet for swallowing difficulty (dysphagia diet), follow the recommended food and drink consistency. For example, in dysphagia diet level 1, thicken liquids to pudding-like consistency.
• Use as little water as possible when brushing the person’s teeth or cleaning his or her mouth.
• Provide oral care before and after meals.
• Use adaptive devices such as cut-out cups, straws, or utensils as told by the health care provider.
• Crush pills and put them in soft food such as pudding or ice cream. Some pills should not be crushed. Check with the health care provider before crushing any medicine.

Contact a health care provider if:

• The person has a feeding tube, and the feeding tube residual amount is too high.
• The person has a fever.
• The person tries to avoid food or water, such as refusing to eat, drink, or be fed, or is eating less than normal.
• The person may have aspirated food or liquid.
• You notice warning signs, such as choking or coughing, when the person eats or drinks.

Get help right away if:

• The person has trouble breathing or starts to breathe quickly.
• The person is breathing very slowly or stops breathing.
• The person coughs a lot after eating or drinking.
• The person has a long-lasting (chronic) cough.
• The person coughs up thick, yellow, or tan sputum.
• If someone is choking on food or an object, perform the Heimlich maneuver (abdominal thrusts).
• The person has symptoms of pneumonia, such as:
  • Coughing a lot.
  • Coughing up mucus with a bad smell or blood in it.
  • Feeling short of breath.
  • Complaining of chest pain.
  • Sweating, fever, and chills.
  • Feeling tired.
  • Complaining of trouble breathing.
  • Wheezing.
• The person cannot stop choking.
• The person is unable to breathe, turns blue, faints, or seems confused.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• Aspiration is the breathing in (inhalation) of a liquid or object into the lungs. Things that can be inhaled into the lungs include food, liquids, saliva, or stomach contents.
• Aspiration can cause pneumonia or choking.
• One sign of aspiration is coughing after swallowing food or liquids.
• Contact a health care provider if you notice signs of aspiration.

Aspiration Precautions, Pediatric

Aspiration is the breathing in (inhalation) of a liquid or other material into the lungs. Things that can be inhaled into the lungs include:

• Food.
• Any type of liquid, such as drinks or saliva.
• Stomach contents, such as vomit or stomach acid.

Aspiration can cause pneumonia. Children who have neurological conditions, such as cerebral palsy, are at risk for aspiration. Infants who have reflux or are premature may also have this condition. You can take steps to reduce the risk of aspiration.

How do I know if my child is aspirating?

Signs of aspiration include:

• Drooling while eating.
• Having a hoarse voice or a change in speech after eating.
• Poor feeding and trouble gaining weight.
• Coughing after swallowing food or liquids.
• Clearing his or her throat often while eating.
• Feeling like something is stuck in his or her throat.
• Having trouble breathing.
• Coughing when lying down or having to sit up quickly after lying down.
• Watery eyes.
• Pain in the chest or back.

What are the complications of aspiration?

Complications of aspiration include:

• Losing weight because your child is not absorbing needed nutrients.
• Choking.
• Lung irritation, if your child aspirates acidic food or drinks.
• Lung infection (pneumonia).
• Collection of infected liquid (pus) in the lungs (lung abscess).

In serious cases, death can occur.

What can I do to prevent my child from aspirating?

Caring for a child who has a feeding tube

If your child has a feeding tube and cannot eat or drink safely through his or her mouth:

• Keep your child in an upright position as much as possible.
• Do notlay your child flat if he or she is getting continuous feedings. If you need to lay your child flat for any reason, turn the feeding pump off.
• Check feeding tube residuals as told by your child’s health care provider. Ask your health care provider what residual amount is too high.

Caring for an infant

• Hold your infant in an upright position with his or her head slightly forward during feedings.
• If your older infant can sit, place him or her in a high chair while eating.
• Watch that your infant is swallowing during feeding. Allow time for your infant to swallow.
• Always watch your child when he or she is eating and drinking.
• Do notlay your infant flat right after eating.
• Follow recommendations from your child’s health care provider about the consistency and types of food that your infant can eat.

Caring for a child who can eat and drink safely by mouth

• Have your child sit in an upright position when eating food or drinking fluids.
• Remind your child to eat slowly and chew well.
• Make sure your child is awake and alert while eating.
• Do not distract your child. This is especially important for children with thinking or memory (cognitive) problems.
• Allow foods to cool. Hot foods may be more difficult to swallow.
• Do not lay your child flat right after eating.
• Follow recommendations from your child’s health care provider about the consistency and types of food that your child can eat.

General instructions

Follow these general guidelines to prevent aspiration in your child who can eat and drink safely by mouth:

• Never put food or liquids in the mouth of a child who is not fully alert.
• Provide oral care frequently and after meals.
• Using adaptive devices, such as cut-out cups, straws, or other utensils, as told by your child’s health care provider.

When should I seek medical care?

• Your child has a feeding tube, and the feeding tube residual amount is too high.
• Your child has a fever.
• Your child tries to avoid food or water, such as refusing to eat, drink, or be fed, or is eating less than normal.
• Your child or infant is not gaining weight.
• You are worried that your child may be aspirating.

Get help right away if:

• Your child has trouble breathing.
• Your child coughs a lot after eating or drinking.
• Your child is choking. If your child is choking, perform the Heimlich maneuver to remove the food lodged in your child’s airway.
• Your child has symptoms of pneumonia, such as:
  • Coughing a lot.
  • Coughing up mucus with a bad smell or blood in it.
  • Feeling short of breath.
  • Complaining of chest pain.
  • Sweating, fever, and chills.
  • Feeling tired.
  • Complaining of trouble breathing.
  • Wheezing.
• Your child cannot breathe, turns blue, faints, or seems confused.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• Aspiration is the breathing in (inhalation) of a liquid or other material into the lungs.
• Aspiration can cause pneumonia.
• Sit your child or infant upright during feedings.
• Always watch your child when he or she is eating and drinking.
• Follow recommendations from your child’s health care provider about the consistency and types of food that your infant or child can eat.