Table 1.

Hypothesized risk factors of pulmonary disease in children with neurological impairment / intellectual disabilities

recurrent aspiration (dysphagia, gastro-oesophageal reflux) [14-16, 20, 28, 53, 54]

inefficient cough / poor cough reflex [14, 15, 28]

poor airway clearance (immobility and retained secretions) [14, 15]

respiratory muscle weakness and in-coordination [14, 15, 28]

chest wall or spinal deformities (poor pulmonary reserve) [14, 15, 28]

inadequate nutritional status (feeding problems, gastro-oesophageal reflux) [14, 15]

miscellaneous factors [2, 8, 10, 14-17]

bronchopulmonary dysplasia in preterm survivors

immune problems (Down's syndrome)

lipid aspiration in mineral oil treatment of constipation

reduced lung growth in skeletal dysplasias

normal childhood factors (e.g. asthma, passive smoking) [14, 15]

immobility [3, 10, 27, 28, 55, 56]