The Rebecca Akuffo-Addo Paediatric Intensive Care Unit (PICU) in the Korle Bu Teaching Hospital embarks on a campaign in July/August every year to help protect children under the broad theme of the “Protect my Little Lungs” campaign.
This came up after numerous deaths in children who were force-fed, and in the process, aspirated and ended up in the PICU.
I vividly remember the case of a Korle Bu staff member who left the child at the day care, only for her to end up dead in the Emergency Room of Korle Bu because the caretaker poured “Tom Brown” into the mouth with the nostrils covered in an attempt to get her to eat.
This is not an isolated case. There is this craze that children should eat all the food offered to them at all costs, and if they don’t eat it all, they are forced to feed.
When these children refuse, different coercive measures are employed to get them to eat. These include threats, caning, emotional blackmail, and in extreme cases, pinning them down and pouring the food into their mouth.
In addition, certain foods such as whole grains and nuts are not to be given to children below the age of two years who are unable to masterfully coordinate swallowing and breathing.
This inability makes it easier for them to aspirate such grains because they can’t protect their airways.
Aspiration is caused by inhaling something other than air into the lungs. Aspiration pneumonia is a bacterial infection in the lungs following an aspiration, or inhalation of something other than air into the respiratory tract.
This can be food, liquid, saliva, stomach acid, vomit or even a small foreign object. Aspiration pneumonitis, on the other hand, is inflammation induced by what was aspirated in the lungs without an infection.
We have all had something “go down the wrong pipe’ and when this happens, we cough it out. Some people are unable to get it out because they are unable to cough from certain factors or diseases.
This leads to a situation where this foreign body ends up in the lungs. This is particularly the case when you have your nose pinched together with food being poured into your mouth.
The presence of the food in the lungs will elicit an inflammatory response (pneumonitis) and pneumonia when it becomes infected.
Symptoms that point to aspiration in general include:
• Fever
• Shortness of breath
• Wheezing
• Coughing
• Chest pain
• Bad breath
• Extreme tiredness
In the case of children, especially those force-fed, they develop rapid difficulty breathing and fast breathing and, in some cases, stop breathing altogether, making ventilatory support very necessary to keep them alive.
It is important to know that the airway, or the breathing pipes, of children is very small, and so a comparatively small amount of foreign substances can have a serious impact.
Aspiration pneumonia can lead to sepsis — a life-threatening reaction to an infection — and respiratory failure.
Diagnosing aspiration pneumonia/pneumonitis relies heavily on the history and the clinical examination findings. When it comes to children, a high index of suspicion is needed even if the history is not typical. “If it looks and smells like aspiration, it probably is” - so clinicians are encouraged to heighten their index of suspicion.
Tests that can help diagnose aspiration pneumonia include:
• Imaging such as a chest X-ray or a CT scan.
• Blood tests for signs of infection.
• Bronchoscopy, where a thin tube (bronchoscope) is used to look inside the lungs.
• Swallowing studies or evaluation by a speech pathologist or an esophagram (barium swallow test) to diagnose swallowing issues.
Mild aspiration pneumonitis/pneumonia is usually treated with antibiotics. Depending on the severity, oxygen therapy or mechanical ventilation while the antibiotics is employed.
Although treatment is commenced early, mild to moderate aspiration gives a good prognosis; severe cases usually succumb to the complications even on the mechanical ventilator.
This calls for a concerted effort for all to prevent force-feeding as a cause of aspiration in children. When the child is hungry, he or she will eat.
There is no need to force the child to feed at all costs, culminating in this life-threatening condition in most instances.
Let us all do our part to ‘protect their little lungs”.
The writer is a member of the Paediatric Society of Ghana and the Medical Director for Korle Bu Teaching Hospital
