Pediatric Dysphagia

Instrumental Assessment

Objectives

Ultrasound
FEESST VFSS/MBS

Instrumental Testing Considerations

Criteria for Referral:
Risk for aspiration by history or findings Prior URI issues Possible pharyngeal/laryngeal etiology Need to define oral-pharyngeal-laryngeal interactions for care planning

Ultrasound
Sound waves

Method:
Transducer sends sound waves; Receives echo back; Echo converted to electronic signal;

Computer generated image.

Advantageous for oral phase problems specific to breastfeeding. See table 8-1 Arvedson & Brodsky (p. 348)

FEESST
Flexible nasopharyngoscopy to look at upper airways Method:
Camera placed in nares; Dye introduced; Visualization of structures before & after swallow;

Advantageous for identification of pharyngeal pooling, premature spilling, laryngeal penetration, apiration, residue, vocal fold mobility, gag reflex, and LAR. See table 8-2 Arvedson & Brodsky (p. 353)

VFSS
Fluoro used in conjunction with barium contrast for dynamic assessment of oral, pharyngeal, laryngeal structures Method:
Conducted with radiologist; Tumbleforms, depending on age;

Contrast of varying viscosity presented;

See table 8-4 for structural & functional information from VFSS Arvedson & Brodsky (p. 356) See table 8-6 Arvedson & Brodsky (p. 362-363) for positioning, equipment options, pros & cons

Special Considerations for High-Risk Pediatrics

Radiologist MUST be present Fluoro-on time minimized typically 2-5 minutes *Minimal attention to therapy maneuvers Include caregivers Always shield reproductive organs with lead apron

Prepare child

More about VFSS

Outlines oral-pharyngeal phases Defines esophageal issues Identifies aspiration factors such as
timing of problems texture specific findings estimated risk

Contraindications for VFSS

High-risk/medically fragileaspiration risk too great for exposure to barium in airways? Unable to drink 30 mL fluid

In Summary
Test US Advantages Good visualization of the oral cavity, no exposure to radiation, body positioning not problematic Disadvantages Shadows cast by laryngeal structures, difficult to discern structural landmarks, pharyngeal visualization difficult

FEESST

Direct viewing of pharynx and larynx (structure and function), portable, no exposure to radiation, doesn't require food/liquid intake

Can only visualize before or after a swallow, cannot assess oral or esophageal phases of swallow, certain level of patient cooperation needed, i.e., ages 6 and under

VFSS/ MBS

Assess all phases of the swallow, motility and coordination, assesses degree of aspiration, can be used with premature infants, real-time images

Exposure to radiation, positioning is key to success, barium contrast, patient must be taken to radiology suite

The End