I: Recurrent aspiration in children with no co-morbidities causes significant pulmonary morbidity with delays in diagnosis.

A: To review the assessment and management of neurotypical children referred to our tertiary respiratory centre with recurrent respiratory symptoms secondary to an unsafe swallow.

M: A retrospective review was conducted of 112 children with recurrent respiratory symptoms referred from from Jan - Dec 2018. Presenting symptoms, first clinician assessment , time intervals from referral to first contact, referral to initial diagnosis, number of specialist teams involved and treatment were collated.

R: 42% of patients had signs of overt aspiration on bedside clinical assessment, of whom 54% were confirmed to have unsafe swallow on videofluroscopic swallow study(VFSS). 37% of those with no signs of overt aspiration were confirmed to have an unsafe swallow on VFSS. Of these, 35% aspirated thin liquids, 15% syrup, 13% custard and 5% purees. 5% were diagnosed with a laryngeal cleft and required IDDSI level 2-3 thickened fluids. 58% of patients saw >3 specialties prior to a definitive diagnosis (SLT, ENT, Neurology, Gastroenterology and Immunology). The median time from referral to first contact was 4 months (IQR 2-7)) and time of referral to diagnosis was 8 months (IQR 3-17.25). Delays were largely attributed to onward speciality referrals. 16% had >5 hospital admissions between referral and diagnosis.

C:The demand for multi-speciality care in this tertiary respiratory cohort reflects the complexity and heterogeneity of unsafe swallow and aspiration. An aerodigestive one-stop clinic model could enable better coordination between specialist teams, early diagnosis and treatment (Hartnick et al. 2020).