Instrumental swallowing assessment in children

Children can present with a wide range of swallowing impairments. This may affect from neonates, infants,toddlers, young children to early teens. The most serious outcome of a severe swallowing impairment is gross aspiration leading to violation of airway and its consequences such as recurrent aspiration pneumonias, sepsis, poor weight gain, failure to thrive and long term developmentalsequel.

Assessment of swallowing is done in children using perceptual clinical swallowing assessment by a speech and language therapist. This isa subjective assessment and may not clearly identify the defective phase of swallowing and may miss silent aspiration.

Instrumental swallowing assessment is a method to identify swallowing impairment by objective evaluation of the entire swallowing process. This would identify the phase and quantify the severity of the impairment. It is mainly done in two ways. i.e. the Functional Endoscopic Evaluation of swallowing (FEES) and Video Fluoroscopic Swallow Study (VFSS).

Both are valuable methods as they separately  assess different phases of swallowing. The results are invaluable in further treatment of these children to overcome or mitigate their impairment. FEES involves inserting a fibro-optic pediatric laryngoscope in the child’s pharynx via the nose and simultaneous observation of swallowing mechanism while feeding orally. VFSS involves fluoroscopic viewing of the swallowing process while giving food mixed with a radio opaque substance. VFSS  is further helpful in intra proceduralpositional maneuversand change in food consistencies to overcome the given impairment.