Diagnosing Respiratory Problems in Neurologically Impaired Children

At Hassenfeld Children’s Hospital at NYU Langone, a team of pediatric specialists works together to diagnose and manage respiratory problems in neurologically impaired children. These breathing difficulties are the result of impairments in the central nervous system, which consists of the brain and spinal cord, and the peripheral nervous system, which is a network of nerves that relays information between the central nervous system and the limbs and organs.

A neurological impairment can affect a child’s muscle strength, movement, speech, memory, learning, or breathing.

Genetic conditions including cerebral palsy, muscular dystrophy, and familial dysautonomia can be associated with congenital airway abnormalities, which are usually present at birth. They can affect any part of a child’s airway, including the nasal cavity; the mouth and tongue; the esophagus, which is the tube that carries food to the stomach; the larynx, or voice box; the trachea, or windpipe; and the lungs.

These conditions may cause inflammation or obstructions in the airway, difficulty clearing secretions from the lungs, or choking.

Another issue is pulmonary aspiration, which is when food particles, liquids, mucus, or saliva are inhaled into the lungs. This is usually caused by problems with swallowing.
Pulmonary aspiration increases the risk of developing aspiration pneumonia, a serious lung infection.

In neurologically impaired children, affected throat muscles can block the airway during sleep, leading to obstructive sleep apnea, in which breathing repeatedly stops and starts. Additionally, weakened muscles in the chest and abdomen can make it difficult to breathe deeply, so that a child must work harder to inhale and exhale.

Children with weakened muscles can have a weak, unproductive cough. As a result, a child may not be able to cough hard enough to clear food particles and secretions from the lungs.

Many children with cerebral palsy have scoliosis, an irregular curvature of the spine that can interfere with the lungs’ ability to expand.

Doctors at Hassenfeld Children’s Hospital use a series of tests to diagnose respiratory problems in children with neurological impairment. When tests require anesthesia, they’re combined into one procedure to minimize the amount time your child spends in testing.

Physical Exam

Your child’s specialist asks if your child has breathing or swallowing problems, including choking, a chronic cough, or sleep apnea. The doctor observes your child’s breathing, and listens to the lungs through a stethoscope.

Diagnostic Tests

Tests are conducted to help the doctor make a diagnosis and determine a treatment plan for children with neurological conditions that affect breathing.

Laryngoscopy

A laryngoscopy helps your child’s doctor check the back of the throat for inflammation and obstructions. This test can detect irregularities in the throat muscles, which assist in breathing and swallowing, and help the doctor assess a child’s ability to breathe.

The doctor may use lidocaine to numb the inside of the nose and throat. Next, he or she inserts a thin, flexible instrument with a high-definition video camera at its end through a nostril and advances it into the airway. The exam takes 10 to 15 minutes and is performed in a doctor’s office.

Sleep Laryngoscopy

A sleep laryngoscopy lets a doctor examine the back of the throat while the child is sleeping. Doctors use this test to check for obstructions that affect breathing during sleep in children with obstructive sleep apnea.

Sedation is used to keep a child still during this test, which takes 10 to 15 minutes.

Bronchoscopy

A bronchoscopy allows the doctor to view the trachea and the air passages in the lungs, called bronchi, to check for obstructions, inflammation, and mucus. The doctor then takes a sample of secretions to determine if food or a bacterial infection has entered the lungs.

In this procedure, a long, thin, flexible instrument called a bronchoscope is inserted through the nose or mouth and into the lungs. A high-definition camera at the tip of this instrument provides clear images, which are sent to a monitor for review.

The procedure requires general anesthesia and takes less than 20 minutes. Our pediatric doctors often perform a sleep laryngoscopy and a bronchoscopy during the same visit to minimize the amount of anesthesia and time required to complete the tests.

Swallowing Study

A specialist may perform a swallowing study to determine if irregularities in the mouth, esophagus, vocal cords, or chest are causing food to enter the lungs. In this study, a series of X-rays, called fluoroscopy, is used to create real-time, video images of the airway.

During this test, your child drinks a flavored contrast agent called a barium shake to help make the airway and any obstructions or inflammation more visible on X-rays. These X-rays track the liquid as it moves through the esophagus.

Unless you are pregnant, you may remain in the room with your child during the test, which takes 30 to 45 minutes.

Pulmonary Function Tests

If your child can follow instructions, pulmonary function tests may be performed at our Pediatric Pulmonary Function Laboratory to measure how well the lungs are working. This series of tests helps measure the amount of air inhaled and exhaled, which shows the doctor how quickly the lungs fill and empty. The tests can also detect any air remaining in the lungs after exhalation.

For instance, during spirometry, a child breathes into a plastic mouthpiece attached to a machine that measures how well the lungs are working.

Sleep Study

Your child’s doctor may recommend an overnight sleep study, called a polysomnogram, to find out if breathing problems are affecting sleep. For a child who is not capable of taking part in pulmonary function tests, a sleep study can determine how efficiently he or she is breathing.

During this test, a sleep specialist tapes or glues painless sensors to the head, face, body, and legs. While your child sleeps, these sensors monitor oxygen and carbon dioxide levels, movement, and snoring. They also record brainwaves.

This study may be performed in the hospital or at NYU Langone’s Pediatric Sleep Disorders Program.

A separate bed or couch is made available to allow you to remain with your child during this study.

CT Scans

Your child’s doctor may use a CT scan to check your child’s respiratory tract for scarring, which can be a sign of injury caused by aspiration or a long-term infection.

A CT scan creates a series of X-ray images of the airway that are transmitted to a monitor for review.

During this test, your child lies on a table that slides into a circular machine. Special headphones that block any noises made by the machine are provided. To help your child remain still during the test, a pediatric anesthesiologist may administer short-acting anesthesia.

This test takes 30 to 45 minutes.

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Respiratory Problems in Neurologically Impaired Children