A Clinical Swallow/Feeding Evaluation is conducted by a Speech-Language Pathologist to determine the presence and severity of dysphagia as well as to determine the need for further testing. Movement of facial muscles, timing of food/liquid movement and airway protection are assessed for varying textures/consistencies to determine the safest diet level. During a pediatric feeding evaluation, body position while feeding, sensory integration, caregiver-child interaction, and behavioral components are also assessed. Based on the assessment, the Speech-Language Pathologist will determine if there is a need for further objective testing with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and/or a Videofluoroscopic Swallow Study (VFSS).
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) uses a thin, flexible, fiberoptic camera passed through the nose and into the throat to view liquids and food consistencies traveling through the throat. These liquids and foods are mixed with food coloring in order to help the Speech Pathologist view them being swallowed. The Speech-Language Pathologist examines for presence of residue in the throat after swallowing, aspiration risks (entrance of food/liquid into airway) and benefit of strategies to improve swallow function.
A Videofluoroscopic Swallow Study (VFSS) is an x-ray examination of the swallow from the mouth through the throat and into the upper esophagus utilizing barium liquids, barium puree, and solids coated with barium. Barium is a white substance that allows the Speech Pathologist to see the food and drink being swallowed during the x-ray. The study is used to evaluate timing of swallow, patient’s ability to transit the food/liquid through the throat into the upper esophagus and risks of aspiration (entrance of food/liquid into airway). Benefits of postures and strategies are examined.
Following evaluation, a specific diet and feeding guidelines may be recommended. The Speech-Language Pathologist may also initiate treatment techniques to improve the patient’s swallowing function. In cases of severe dysphagia, it may be recommended that the patient discontinue eating food and/or liquids by mouth to avoid infection or difficulty breathing. An alternative method of receiving nutrition, hydration and medication (feeding tube) may be needed for a short time or long term depending on the individual.