Cervical Auscultation in Pediatrics

Thought you might find these recent articles on cervical auscultation in pediatrics informative. The evidence base is in its infancy but these papers are by the well-respected group in Queensland, Australia. Both articles reflect the value of instrumental assessment of swallowing physiology along with limitations of CA.

The Use of Cervical Auscultation to Predict Oropharyngeal Aspiration in Children: A Randomized Controlled Trial

Aspirating and Nonaspirating Swallow Sounds in Children: A Pilot Study

One highlights descriptors for swallowing and breath sounds. Using CA, the presence of a glottal release sound along with normal breath sounds post-swallow are possible indicators of a non-aspirating swallow. Conversely, the presence of wet breathing and 1 or more of the following sounds: cough, wheeze, crackles, throat clearing, and stridor are indicative of an aspirating swallow, when compared to VFSS. Clinicians are encouraged to refer for further instrumental assessment of feeding/swallowing skills in the absence of these perceptual parameters and/or presence of abnormal respiratory sounds post-swallow. Further research comparing the acoustic swallowing sound profiles of normal children to children with dysphagia (who are aspirating) on a larger scale is required.

The other paper looks at use of CA in relationship to predicting aspiration. Although they found that using CA as an adjunct to the clinical feeding evaluation improves the sensitivity of predicting aspiration in children, it is not sensitive enough as a diagnostic tool in isolation.

I have always made it a practice to listen to normal newborns in the Newborn Nursery and infants I follow in NICU via CA, just to build my “scaffolding” if you will as to what breathing and swallowing sounds like under auscultation. If you have not, listen. I am intrigued by what I hear when I listen to infants via CA with both known and suspected airway and/or swallowing problems. We lack guidelines and training formats to yield objective data, but these articles add to our information base and advance the science.

I hope you enjoy them as much I did.


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