Aerodigestive / ENT

Pediatric aerodigestive disease demands multidisciplinary evaluation because single-organ thinking misses the diagnosis. Infants presenting with vomiting and respiratory symptoms more often have oropharyngeal dysphagia than reflux [e289-c1, e359-c1], yet PPIs remain overused despite lack of efficacy under age 1 (infants reflux non-acidic milk) [e289-c3, e359-c3] and known harms including sepsis, NEC, and C. diff [e289-c5, e359-c5]. Eosinophilic esophagitis appears in 10% of children under 5 with respiratory symptoms [e289-c6, e359-c6], presenting as chronic cough rather than dysphagia [e289-c7, e359-c7]; dairy drives 60–70% of cases [e289-c9, e359-c9], and wrapping a child with undiagnosed EoE is catastrophic [e289-c8, e359-c11]. Laryngeal clefts are underdiagnosed—flexible bronchoscopy misses them 95% of the time; rigid bronchoscopy with probing is required . TEF patients warrant lifelong surveillance: presumed tracheomalacia until proven otherwise , at least three endoscopies (post-PPI, pre-age-10, transition to adulthood) , and awareness that two-thirds show histopathologic airway changes even without visible inflammation . Fundoplication in the aspirating child worsens outcomes—saliva pools above the wrap, triggering gagging and cough [e289-c27, e359-c36]. Blenderized feeds migrate to the antrum, reducing reflux [e289-c28, e359-c25], and minimal-mobilization Nissen technique has driven transmigration to zero in recent series [e289-c26, e359-c21]. Button batteries lodged at the aortic arch kill via coagulative necrosis and delayed aortoesophageal fistula; sentinel bleeds appear >2 weeks post-removal . For recurrent croup, the differential is asthma (39%), bacterial bronchitis (17%), or both (42%)—not isolated airway pathology .