Aerodigestive Tract Disorders

The breathing airway and the digestive system share the mouth and throat down to the voice box (larynx). The airway and digestive tract and are so close together that a problem in one often results in a problem in the other, so the two are often considered together as a unit called the "aerodigestive tract."

If your child has an aerodigestive tract disorder, you can trust the internationally recognized specialists, surgeons and researchers throughout Nemours Children’s Health System to provide advanced, life-enhancing care for your child and family.

 
Read More About Aerodigestive Tract Disorders

Aerodigestive tract disorders can affect a child’s physical health and functioning, and can also impact healthy social and emotional development. While there is no single cause for these conditions, there are many treatments available to correct and manage aerodigestive tract disorders and related conditions so that your child can live a happy, independent life.

Some of our Nemours locations feature coordinated multidisciplinary aerodigestive disorders programs where your family can see specialists from areas such as otolaryngology (also called “ear, nose and throat,” or “ENT”), pulmonology, medical imaging (radiology), speech and language therapy, gastroenterology (GI) and nutrition during a single visit. Our experts work together, with you, to develop a treatment plan that cares for your child in the short and long term.

Expert Care You Can Trust

At Nemours, our pediatric aerodigestive tract disorders programs include highly specialized, board-certified and fellowship-trained pediatric experts (ear, nose and throat surgeons, gastroenterologists, pulmonologists, general surgeons, cardiothoracic surgeons and more) who have extensive experience providing innovative, researched-based treatments, including minimally invasive endoscopic procedures for even our tiniest newborn patients.

Working together with other pediatric medical specialists, we also anticipate and manage problems with feeding/swallowing, breathing and speech that may occur as your child grows and develops. Our pediatric aerodigestive tract disorders programs offer coordinated, family-centered care to streamline the management of complex aerodigestive tract disorders.

Types of Aerodigestive Tract Disorders We Treat

At Nemours, we treat nearly every pediatric aerodigestive problem, from the mild to the most severe conditions. Aerodigestive tract disorders we treat include:

  • airway stenosis (narrowing of the larynx, windpipe or its branches to the lungs)
  • aspiration (inhalation of food, liquid or saliva into the lungs)
  • breathing problems caused by narrowing or weakness of the airways
  • congenital pulmonary airway malformation (problem developed before birth)
  • dysphagia (swallowing problems)
  • eosinophilic esophagitis (inflammation of the esophagus causing narrowing of the opening)
  • esophageal atresia (esophagus doesn’t connect to the stomach)
  • esophageal diverticuli (pockets on the inside side of the esophagus that can trap food)
  • foreign body management
  • gastroesophageal reflux disease (GERD; passage of stomach contents upward through the esophagus)
  • laryngomalacia (softening of the tissues of the larynx [voice box] and the most common cause of noisy breathing in infants)
  • tracheoesophageal fistula (opening between the windpipe and esophagus)
  • tracheomalacia (thinning or weakness of the trachea)
    tracheotomy
Symptoms of Aerodigestive Tract Disorders

Aerodigestive disorders vary from mild to severe, and the symptoms can be obvious or subtle. Symptoms may be present at birth or develop over time. Some common symptoms and complications from aerodigestive tract disorders include:

  • dysphagia (difficult or painful swallowing)
  • inability to swallow
  • breathing difficulty
  • frequent vomiting or regurgitation of food
  • frequent lung infections
  • persistent coughing or choking after feeding
  • bad breath
  • drooling
  • noisy or high-pitched breathing
  • inability to speak or hum
  • failure to thrive
  • lack of normal weight gain
  • stridor (wheezing or other sounds from the upper airway)
  • hoarseness

Nemours specialists look for and manage all symptoms of aerodigestive tract disorders in children.

Nemours/Alfred I. duPont Hospital for Children, Wilmington


1600 Rockland Road
Wilmington, DE 19803
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For Appointments: (302) 651-4200

For Information: (302) 651-5895

Hours: Monday–Friday, 8 a.m. to 5 p.m.

 
What to Bring
  • photo ID
  • medical and pharmacy insurance cards
  • preferred pharmacy name and phone number
  • names and dosage of all medications, including over-the-counter medication, your child is currently taking
  • guardianship and custody papers, if a legal guardian rather than a parent accompanies your child
Returning Patients
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
 
Forms & Resources
Returning Patients
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
Resources for Patients & Families

The Aerodigestive Program at Nemours/Alfred I. duPont Hospital for Children provides diagnostic and treatment expertise for children throughout the Delaware Valley region who have aerodigestive tract disorders (problems involving the upper portions of the airway or digestive tract).

At Nemours, we provide support, education and long-term care for your child today and throughout future growth and development. The physicians in the Aerodigestive Program work together to minimize the number of tests, exposures to radiation (such as X-rays and CT scans) and anesthesia that are required to gather the information necessary to reach an accurate diagnosis and treatment plan.

Specialized Care for Aerodigestive Tract Disorders

The Aerodigestive Program at Nemours/Alfred I. duPont Hospital for Children includes physicians, advanced registered nurse practitioners (ARNPs) and physician assistants (PAs) who have special training in aerodigestive tract disorders. Because we understand the physical, social and emotional impact a complex medical condition can have on a child during growth and development, we work to restore function and preserve the confidence and happiness that every child deserves.

 
Aerodigestive Tract Disorders We Treat

At Nemours/Alfred I. duPont Hospital for Children, we treat nearly every aerodigestive tract disorder from mild to extremely complex cases, including:

  • airway collapse (supraglottic — above the vocal cords)
  • airway stenosis, tracheal stenosis, laryngeal stenosis or glottic stenosis (narrowing of the windpipe, voice box or vocal cords)
  • bronchomalacia (weakness or malformation of the airways branching to and in the lungs)
  • dysphagia (difficult swallowing, painful swallowing or inability to swallow)
    eosinophilic esophagitis (inflammation of the esophagus causing narrowing)
  • follow-up for esophageal colon interposition (replacing part of the esophagus with a piece of intestine)
  • gastroesophageal reflux disease (GERD, flow of stomach contents to the throat or mouth)
  • laryngeal cleft (an opening between the esophagus and the larynx)
  • laryngomalacia (weakness or malformation of the larynx)
  • problems with airway protection (coughing, choking)
  • repeat Nissen fundoplication (surgery for gastroesophageal reflux disease/GERD)
  • sleep apnea (long pauses or interruption of breathing rhythm while sleeping)
  • slow or inadequate weight gain
  • supraglottic cysts
  • tracheoesophageal fistula (TEF; abnormal connection of the windpipe with the esophagus)
  • tracheomalacia (weakness or malformation of the trachea)
  • tracheostomy-related care (includes use of speaking valve, upsizing for your child’s growth, stoma care, assessing for decannulation, closure of
    unhealing stoma, etc.)
  • vascular compression of the trachea
  • ventilator-dependent disorders
  • vocal cord paresis (weakness) or paralysis
 
A Team Approach to Your Child’s Care

To give your child the very best treatment, our expert pediatric surgical and medical doctors work together as a team with any other specialists who may be involved in your child’s care. We also work closely with the nursing and anesthesiology teams, so everyone involved is well-informed on your child’s behalf.

Our aerodigestive tract disorders program includes specialists from otolaryngology (also called ear, nose and throat or ”ENT”), pulmonology, gastroenterology (GI), cardiothoracic surgery and general surgery. In addition to the doctors listed above, your child’s care team members may include speech-language pathologists, dietitians and other care team members.

Your child’s aerodigestive tract disorder care team may also include:

Our program coordinator will serve as your point of contact. Your child will be assigned to a lead service: either ENT, pulmonology, gastroenterology, general surgery or cardiothoracic surgery.

Throughout your child’s care, we count on you as an important member of the team, because no one knows your child better than you do. We know that dealing with a medical condition can be overwhelming at times, so we take steps to make sure you and your child understand what’s going on every step of the way — and that you have tools to help you and your child cope with all of the emotions and stresses you may be feeling.

Diagnosing and Treating Pediatric Aerodigestive Tract Disorders

Your child’s evaluation in the Aerodigestive Program will begin with a diagnostic appointment with one of our pediatric experts in aerodigestive tract disorders and other team members as needed. We can often make a diagnosis at the time of the initial evaluation, but depending on your child’s symptoms and condition, we may recommend additional diagnostic testing (often the same day) and schedule further evaluation with other pediatric specialists — with appointments in days, not weeks.

 
Your Child’s First Visit: What to Expect

During your child’s first visit, we will:

  • obtain your child’s medical history and family medical history
  • review your child’s medical records and previously obtained X-rays and tests (if available)
  • perform a detailed physical examination
 
If Your Child Needs Additional Diagnostic Tests

Although most conditions can be diagnosed by a physical examination, we may need to order additional tests, including:

  • bronchoscopy (to check for airway problems)
  • CT scans (computed axial tomography, also called “CAT scans”)
  • endoscopy (The doctor slides a thin, flexible plastic tube called an “endoscope” down the throat and into the esophagus and the stomach. A tiny camera in the endoscope lets the doctor look for abnormalities on the surface of the esophagus and stomach lining. Our experts will coordinate so that your child only needs anesthesia one time.)
  • molecular tests (to look at genetic makeup)
  • MRI (magnetic resonance imaging)
  • sleep studies (to check for obstructive sleep apnea)
  • speech and swallowing evaluations
  • X-rays of the head, neck, chest and abdomen
 
Treatments for Pediatric Aerodigestive Tract Disorders

At Nemours, we take a conservative approach to treating aerodigestive tract disorders in children. And because every child is different, our treatment plans are individualized. Treatments may include close follow-up (watchful waiting as your infant grows) or rehabilitation therapies (speech/feeding and swallowing and others).

When surgery is necessary to correct and protect physical form and function, we perform a wide variety of procedures on even the tiniest newborns. You can trust that we’ll take the time to help you understand the different options, risks and expected outcomes.

Some of the procedures we perform to help kids with aerodigestive tract disorders are:

Laryngotracheal Reconstruction: Laryngeotracheal reconstruction (LTR) may be needed due to laryngeal or tracheal stenosis or blockage. In rare cases, severe thinning or weakness of the trachea, which is called tracheomalacia, may develop after tracheostomy.

LTR increases the size of the airway by splitting the narrowed segment of cartilage rings and using cartilage grafts to increase the diameter of the trachea. Most grafts are made of cartilage taken from the ear, rib or thyroid cartilage. This graft is held in place by a plastic tube called a stent; this stent is often a breathing tube (endotracheal tube) placed into the airway during the surgery and removed several days after surgery. Successful LTR allows the removal of a tracheotomy tube, if one has been necessary to maintain an airway.

LTR can be performed one of two ways, in a single stage surgery (ssLTR), or in a double stage surgery (dsLTR). With either technique, follow-up after discharge from the hospital is required to determine whether the graft is healing and to see whether a kind of scarring called granulation tissue is narrowing the airway. If granulation tissue forms, another visit to the operating room may be required for examination of the granulation tissue under anesthesia.

Single Stage LTR: If your child has a tracheostomy tube, it will be removed during the surgery and the hole (or stoma) will be closed. There will be a cut in the neck where the surgery was done. A small drain will be placed in the neck to collect fluid and air after the surgery. If rib cartilage is used, there will be a small cut on the chest with a drain in place there, too. A breathing tube will remain in the nose after the surgery. The breathing tube keeps the airway open and supports the graft while the tissues heal so the airway does not shrink. Your child’s ENT doctor will decide how long the breathing tube and drains stay in place.

Double Stage LTR: In a double staged procedure (dsLTR), the tracheostomy tube will stay in place. The hole (stoma) may be moved during the procedure. There will be a cut in the neck where the surgery was done. A small drain will be placed in the neck to collect fluid and air after the surgery. If rib cartilage is used, there will be a small cut on the chest with a drain in place there too. A stent may be placed in the airway to support the graft. Your child’s ENT doctor will decide how long the stent and drains stay in place.

Slide Tracheoplasty: When your child has fully formed cartilage rings that prevent the windpipe from growing as your child grows, slide tracheoplasty is used to widen the windpipe and allow growth. Slide tracheoplasty expands and shortens the trachea by splitting it so the cartilage rings are opened in the front and back. Cardiopulmonary bypass, which allows a machine to do all the breathing for your child while surgeons work on the trachea, may be required to complete this surgery. After the surgery, your child will remain in the hospital and breathe through a tube while the trachea heals.

Supraglottoplasty: For children with severe laryngomalacia, surgeons may perform a procedure called a “supraglottoplasty.” During a supraglottoplasty, extra tissue is removed around the voice box, allowing your child to breathe more easily.

Tracheostomy: If needed, surgeons may perform a procedure called a “tracheostomy,” or "trach." During a tracheostomy, a plastic tube is surgically placed into the trachea, or windpipe. The tube keeps the pathway open for air to reach the lungs. Sometimes the tube is attached to a ventilator to help kids breathe.

Convenient Care and Support for the Entire Family

Our pediatric surgery center is located on the second floor of the duPont Hospital for Children, a hospital set in a beautiful park of oaks and green lawns, and featuring free parking for families.

If your child is getting surgery and needs to stay overnight, our rooms are designed to be kid- and family-friendly. And each unit has a play area/lounge to give both children and families a special place of their own to enjoy away from their hospital room. Kids’ rooms are equipped with a bathroom and a special touch-screen TV that offers entertainment and educational options through a program called the GetWellNetwork. And, to help you be there as much as possible for your child, our rooms allow one parent to stay with their child overnight.

 
Support for You and Your Family During Overnight Hospital Stays

If you need a place to relax, unwind or just take a moment for yourself during your child’s hospitalization, visit the Family Resource Center and Ronald McDonald Family Room, located on the third floor of the hospital. Thanks to this joint project of duPont Hospital for Children and the Ronald McDonald House of Delaware, you can enjoy 24/7 access to:

  • comfortable bathroom and shower facilities
  • computers
  • copier
  • fax machine
  • free Internet access and wireless service
  • kitchenette with microwave to make snacks or a light meal
  • laundry facilities
  • library with books and periodicals from the Auxiliary
  • low-cost vending machines
  • printers
  • telephones (with free long distance)
  • three quiet sleep rooms (reserve by contacting the social worker assigned to your child’s unit)

The Family Resource Center also features an education area, available by appointment, where you can learn skills necessary to care for your child’s special medical needs.

Learn More About Support Services at duPont Hospital for Children »

 
Convenient Follow-up Appointments in Your Neighborhood

Some of the very same surgeons, gastroenterologists and nutritionists you may see at Nemours/Alfred I. duPont Hospital for Children also provide follow-up appointments at our convenient Delaware Valley specialty care locations.

Electronic Health Record: Keeping Track of Your Child’s Progress

No matter where your child receives care at Nemours, your medical team (including your primary care provider) can access your child’s medical history, test results and visit notes anytime through our award-winning electronic health record system.

You can also view parts of your child's health records, communicate with your Nemours care team, make appointments, request prescription refills and more through our MyNemours online patient portal.

Learn more about MyNemours »

Top 10 Things Kids Need to Know About Surgery

Take your child on a pediatric surgery video tour with Sheridan on her surgery day. This fun, kid-friendly video shows children and teens what to expect, step-by-step, if they need an operation at Nemours/Alfred I. duPont Hospital for Children.

 
After Tracheal Reconstruction or Other Major Surgery

After tracheal reconstruction or other major surgery, your child will be cared for and closely watched in the pediatric intensive care unit (PICU). Medicine will be given to your child to reduce the chance of accidental removal of the breathing tube, which helps protect the airway as it heals.

The surgical team may return your child to the operating room for laryngoscopy and bronchoscopy (DLB) to see how well the airway is healing. After the breathing tube is removed, your child’s breathing will be monitored. When the medicines that induce relaxation are stopped, some children may feel or appear shaky (a process called withdrawal) for a short period of time.