Fiberoptic endoscopic evaluation of swallowing in the pediatric population.
OBJECTIVE
To investigate the diagnostic and rehabilitative usefulness of routine fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric population.


METHODS
Prospective, consecutive, blinded.


METHODS
Thirty pediatric inpatients from a large, urban, tertiary care teaching hospital participated. Their ages ranged from 11 days to 20 years (mean, 10 years and 4 months). In a random fashion, seven subjects were assessed with both videofluoroscopic evaluation of swallowing (VFES) and FEES and 23 subjects were assessed solely with FEES. Diagnosis of dysphagia was determined by spillage, residue, laryngeal penetration, and aspiration. Rehabilitative strategies, e.g., positioning and modification of bolus consistencies, were based on diagnostic findings.


RESULTS
There was 100% agreement between the blinded diagnostic results and implementation of rehabilitative strategies for subjects randomly assigned to receive both VFES and FEES and for subjects who received solely FEES. Of the 23 subjects assessed solely with FEES, 13 of 23 (57%) exhibited normal swallowing and 10 of 23 (43%) exhibited dysphagia. The feeding recommendation for 4 of 10 subjects with dysphagia (40%) was for a non-oral diet because of aspiration. FEES allowed for specific feeding recommendations (i.e., bolus consistency modifications, positioning, and feeding strategies) to reduce aspiration risk in 6 of 10 subjects with dysphagia (60%).


CONCLUSIONS
FEES can be used routinely to diagnose and treat pediatric dysphagia in the acute care setting.
Leder
S B
SB
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA. Steven.Leder@Yale.edu
Karas
D E
DE
D000293:Adolescent; D002648:Child; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation; D004311:Double-Blind Method; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D014743:Videotape Recording