Respiratory complications of neurodisability in children and young people

Abstract

Respiratory problems are common in children with a neurodisability. These respiratory issues are a common cause of morbidity and death. Children with neurodisability are at particular risk of respiratory infection due to impaired respiratory drive, poor cough strength an increased cough threshold and aspiration. This leads to recurrent infections and eventually to chronic bacterial infection in many cases. Gastro-oesophageal reflux, muscle weakness and development of kyphoscoliosis may also contribute to chronic ongoing morbidity. Common paediatric respiratory conditions such as asthma and chronic lung disease of prematurity may co-exist, complicating the presentation. The adverse effects of polypharmacy needs to be considered carefully. To optimize care of children with medical complexity, a multidisciplinary team should include a respiratory physician and physiotherapist. This short article provides an overview of the evidence for optimal respiratory care for children with neurodisability and, in the absence of such, offers some practical advice based upon the experience of the author.