Pediatric Pulmonology 41:912–915 (2006) Original Articles Aspiration During Swallowing in Typically Developing Children of the First Nations and Inuit in Canada Gina R. Rempel, MD, 1,2 * Barbara L. Borton, OTM, 2 and Rajesh Kumar, MD 3 Summary. Children of the First Nations and Inuit in Canada have a high propensity for lower respiratory tract infections. Overcrowding, poor housing, passive smoke exposure, and lack of breast feeding (Martens P, Bond R, Jebamani L, Burchill C, et al. http://www.umanitoba.ca/centres/ mchp/reports/pdfs/rfn_pdfs/rfn_report.pdf.; MacMillan H, Walsh C, Jamieson E, Crawford A, Boyle M. http://www.hcsc.gc.ca/fnihbdgspni/fnihb/aboriginalhealth/reports_summaries/ regional_sur- vey_ch1.pdf.; Wardman AE, Khan NA. Int J Circumpolar Health 2004;63:81–92) have been cited as important contributing factors in the occurrence of lower respiratory tract infections. However, aspiration during swallowing has thus far not been considered as a co-factor in the occurrence of lower respiratory tract infections in these children. We present a retrospective case series of seven typically developing children of the Canadian First Nations and Inuit, in whom aspiration during swallowing was detected in the course of investigating associations with recurrent lower respiratory tract infections. None of the children had any of the known risk factors for aspiration during swallowing such as developmental variation, prematurity, neuromotor problems, or anatomic abnormalities of the upper aerodigestive tract. We speculate that aspiration during swallowing in typically developing children may be an important, previously unrecognized co-factor in the occurrence of lower respiratory tract infections, particularly in the communities of the Canadian First Nations and Inuit. Further prospective studies will be needed to determine whether aspiration during swallowing represents an independent risk factor for the occurrence of lower respiratory tract infections in these children. Pediatr Pulmonol. 2006; 41:912–915. ß 2006 Wiley-Liss, Inc. Key words: aspiration during swallowing; First Nations children; Canadian aboriginal children; pneumonia; lower respiratory tract infection. INTRODUCTION Aspiration of food or liquid during swallowing has been described in a wide range of children with developmental disabilities, 4,5 children with anatomic abnormalities such as tracheoesophageal fistulas or laryngeal clefts, and infants born prematurely. 6 In these children, the mechan- ical act of feeding and swallowing may be impaired due to inefficient food propulsion, poor coordination of breath- ing and swallowing, inappropriate triggering of swallows, and delayed utilization of airway protective responses. These factors increase the risk of aspiration during swallowing, 7 which in turn may be associated with the accompanying complications of aspiration pneumonia. 8 Few reports on aspiration during swallowing discuss the occurrence of this problem in typical children. 9–11 None of them discuss a predisposition to aspiration during swallowing related to environmental, social, or biological factors, which may account for clustering of cases in 1 Departments of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada. 2 The Rehabilitation Centre for Children, Inc., Winnipeg, Canada. 3 The Department of Pediatrics, Children’s Memorial Hospital, Chicago, Illinois. Grant sponsor: Rehabilitation Centre for Children Foundation, Winnipeg, Canada. *Correspondence to: Gina R. Rempel, MD, AE 103 Children’s Hospital, 840 Sherbrook Street, Winnipeg, MB, Canada R3A 1S1. E-mail: grempel@cc.umanitoba.ca Received 24 May 2005; Accepted 11 December 2005. DOI 10.1002/ppul.20489 Published online 24 August 2006 in Wiley InterScience (www.interscience.wiley.com). ß 2006 Wiley-Liss, Inc.