Aerodigestive Program

The experts in the Aerodigestive Program at University of Missouri Health Care treat children who have airway abnormalities, digestive issues and pulmonary conditions that affect their eating, speaking, breathing or sleeping.

The term aerodigestive refers to the organs and tissues of the respiratory tract and the upper part of the digestive tract. This includes the oropharynx (mouth and throat), larynx (voice box), trachea, lungs, esophagus and stomach.

Conditions of the aerodigestive system often are complex because each of the systems is interconnected, and a problem in one system can cause issues in another. This requires a team of experts from each of the relevant medical specialties to properly diagnose and treat your child's symptoms.

Conditions treated by the Aerodigestive Program

The typical child with aerodigestive issues is an infant, toddler, or child who experiences one or more of the following:

  • Difficulty with feeding
  • Failure to thrive
  • Frequent choking episodes while feeding
  • A wet cough and voice
  • A history of recurrent pneumonia
  • A recurrent illness resembling a cold that requires hospitalization
  • An early diagnosis of asthma (younger than 6 months)

Sometimes, these children have been born premature, had a stay in the Neonatal Intensive Care Unit (NICU), or had a diagnosis of cerebral palsy, global developmental delays, or a genetic syndrome. Our team of experts works together to evaluate your child's case, conduct the needed evaluations and then develop a personalized treatment plan to help your child get better.

Conditions treated include:

  • Laryngotracheoesophageal cleft: a rare, inherited disorder in which the throat doesn’t connect to the esophagus as it should. Sometimes this may result in children inhaling food.
    • Our Pediatric Ear, Nose and Throat (ENT) team has performed more than 40 cases of surgical repair over the past two years, and this procedure significantly improves a child’s swallowing function.
  • Laryngomalacia: soft tissue in the voice box extends over the opening of the airway and creates noisy and breathing difficulties
  • Tracheomalacia or bronchomalacia: the airways are softer or floppier than typical and may create noisy breathing and wheezing
  • Subglottic stenosis: a narrowing of the airway below the voice box
  • Stridor: noisy breathing
  • Vocal cord dysfunction/paralysis
  • Reoccurring croup
  • Aspiration pneumonia/pneumonitis, or reoccurring pneumonia
  • Chronic cough
  • Eosinophilic Esophagitis: an autoimmune disease that increase inflammation in the esophagus
  • Gastroesophageal reflux (GERD)
  • Feeding disorders such as dysphagia, or swallowing difficulties, chronic aspiration, G-tube dependency
  • External esophageal or airway compression from a vascular ring or sling: rare conditions in which blood vessels are wrapped around the esophagus or airway, causing obstruction and difficulty with swallowing and breathing

Diagnosing aerodigestive problems

Our team of experts in the Aerodigestive Program includes specialists from otolaryngology (ear, nose and throat), pulmonology (lung), gastroenterology (digestive tract), speech pathology (feeding and swallowing), and nutrition (registered dietitians). The team also consults with specialists in pediatric surgery, pediatric anesthesia, pediatric neurology, pediatric physical medicine and rehabilitation, and genetics, as needed.

Our team provides a coordinated approach to evaluation of aerodigestive problems and uses a variety of approaches to diagnose aerodigestive problems in children. These might include laboratory studies, pulmonary function testing, impedance/pH probe, video fluoroscopic study (swallow study), esophagram, chest X-ray, chest CT, and flexible laryngoscopy.

For many children, an evaluation of the entire upper aerodigestive tract might be recommended. This includes a direct rigid laryngobronchoscopy (DLB) by a pediatric otolaryngologist, a flexible bronchoscopy with bronchoalveolar lavage (BAL) by a pediatric pulmonologist, and an esophagogastroduodenoscopy (EGD) with biopsies by a pediatric gastroenterologist. These evaluation studies, taken together, are called triple endoscopy or "triple scope." This comprehensive evaluation provides direct observation and allows for diagnoses that might be missed with just one procedure.

Treatment and follow up

Once we have met your child and reviewed his or her evaluation tests, our team meets as a group to discuss diagnosis and develop a tailored treatment plan. The plan likely will include dietary modifications, medications, and could involve surgery. Depending on your child's needs, we may complete some follow-up visits using telehealth.