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)
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 Children's Specialty Care, Jacksonville

807 Children’s Way
Jacksonville, FL 32207
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For Appointments: (904) 697-3600

We offer same-day appointments when available or schedule your child to be seen within five business days.

Hours: Monday–Friday, 8 a.m. to 5 p.m.
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What to Bring
  • your photo ID
  • insurance and/or Medicaid cards
  • referral from your referring physician (if required by your insurance)
  • co-payment, if applicable
  • legal guardianship or custody papers if you are not the patient’s parent
If available, please provide:
  • preferred pharmacy contact information
  • names and dosages of all medications your child is taking (including over-the-counter medications)
  • name and number of your primary care physician
  • parent (and child’s) social security numbers
  • parent work information (address, telephone numbers)
  • immigration information (if your child was not born in the United States)
  • list of prior immunizations
New Patients
  • Patient Registration (PDF)
Returning Patients
  • Release of Information (PDF)
    English | Spanish
  • 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
New Patient Forms
  • Patient Registration (PDF)
Returning Patient Forms
  • Release of Information (PDF)
    English | Spanish
  • 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 Children’s Specialty Care, Jacksonville provides diagnostic and treatment expertise for children of Northeast Florida and Southeast Georgia — in collaboration with Wolfson Children’s Hospital and University of Florida Health — with complex problems involving the upper 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.

The Nemours Aerodigestive Program includes specialists from otolaryngology (also called ear, nose and throat or “ENT”), pulmonology, gastroenterology, general surgery, cardiothoracic surgery, speech therapy and anesthesiology. In addition to the doctors listed above, your child’s care team may include speech pathologists, dietitians and other care team members.

Learn More About Pediatric Otolaryngology (Ear, Nose and Throat) Care at Nemours Children’s Specialty Care, Jacksonville »

Specialized Care for Aerodigestive Tract Disorders

The Aerodigestive Program at Nemours Children’s Specialty Care, Jacksonville is sponsored by Nemours Children’s Health System and supported by Wolfson Children’s Hospital, Mayo Clinic and University of Florida Health, Jacksonville. The Aerodigestive Tract Disorders team 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 tirelessly to restore function and preserve the confidence and happiness that every child deserves.

Here at Nemours Children’s Specialty Care, Jacksonville your child can come in for an evaluation, diagnosis and follow-up care for surgery performed by our board-certified surgeons at our neighboring affiliate, Wolfson Children’s Hospital (ranked among the country’s best hospitals for children by U.S. News & World Report).

Wolfson Children’s Hospital is one of the many health care organizations we work with to make it easy for your child to get Nemours’ quality of care. This unique affiliation enables us to offer 24-hour emergency, inpatient and consultative services to the babies, kids and teens of northeast Florida and southern Georgia.

Aerodigestive Tract Disorders We Treat

At Nemours Children’s Specialty Care, Jacksonville 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)
  • anatomic intestinal issues (unusual intestine structure that causes problems)
  • aspiration
  • bronchomalacia (weakness or malformation of the airways branching to and in the lungs)
  • dysphagia (difficulty swallowing, painful swallowing or inability to swallow)
  • eosinophilic esophagitis (inflammation of the esophagus causing narrowing)
  • esophageal atresia or EA (incomplete formation of connection from mouth to stomach)
  • esophageal dysmotility or dysfunction (lack of movement or other disorder of the esophagus)
  • esophageal strictures  (narrowing of the esophagus)
  • esophageal webs (thin folds of tissue blocking part of the passage)
  • follow-up for esophageal colon interposition (replacing part of the esophagus with a piece of intestine)
  • gastroesophageal reflux (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)
  • malabsorption (inability to absorb adequate nutrition from ingested food)
  • 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 and vallecular cysts
  • tracheoesophageal fistula or 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
  • vascular malformations involving the aerodigestive tract
  • 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 surgeons and specialists work together as a team. 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’re coping with all of the emotions and stresses you may be feeling.

In addition to the doctors listed above, your child’s aerodigestive tract disorders care team may include:

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’ll:

  • 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

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

  • X-rays of the head, neck, chest and abdomen
  • endoscopy (our experts will coordinate so that your child only needs anesthesia one time)
  • CT scans (computed axial tomography, also called CAT scans)
  • MRI (magnetic resonance imaging)
  • bronchoscopy (check for airway problems)
  • sleep studies (obstructive sleep apnea)
  • molecular tests (genetic makeup)
  • speech and swallowing evaluations
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.

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.

Convenient Care and Support for the Entire Family

Dealing with a chronic or complex medical condition can sometimes be difficult for your child and family, but you don’t have to go through it alone. Nemours Children’s Specialty Care, Jacksonville provides an array of support services that begin on the very first day we meet, and continues throughout your journey.

Support Services at Nemours Children’s Specialty Care, Jacksonville

Nemours support services in Jacksonville include a Child Life program, creative therapy, a family advisory council, interpreters, a family resource library, and the Ronald McDonald House across the street.

In addition to expert medical care, our nurse navigators, educators, social workers and Child Life specialists provide:

  • care coordination: scheduling multiple appointments, tests, procedures and at-home care at convenient times and places
  • communication: keeping your primary care physician and community providers informed and in the loop
  • collaboration: helping you create a support system and connecting you with families that are on the same journey
  • patient and family education: providing information about your child’s condition, treatments, clinical trials and recent research at our resource library
  • encouragement at the hospital and clinic: offering medical play therapy and procedure/surgery demonstration to ease fears
  • advocacy: offering a voice for your child and family to secure appropriate services at school and in the community
  • seminars and training

Learn More About Support Services at Nemours Children’s Specialty Care »

Learn More About the Ronald McDonald House in Downtown Jacksonville »

Convenient Follow-up Appointments in Your Neighborhood

For your convenience, some of the specialists you see at Nemours Children’s Specialty Care and Wolfson Hospital provide follow-up appointments at our Jacksonville South and Fleming Island locations.

The Nemours Commitment to Family-Centered Care

At Nemours, we recognize the importance of the family in the care and healing process. We understand that no one knows your child better than you do — and that you’re one of the most important members of your child’s care team. That’s why we make every effort to include you in the process and to create a close relationship built on mutual respect, collaboration and education.

Learn More About the Nemours Commitment to Family-Centered Care »

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

To ensure everyone is on the same page (including your primary care provider or pediatrician) your entire medical care team has access to our award-winning electronic health record system that keeps track of every visit, every test result and every procedure at Nemours.

And you can access select parts of your child’s health record through MyNemours, our secure portal that allows you to interact with your care providers and request prescription refills online, anytime.

Learn More About MyNemours »