Problem Solving: VFSS orders from GI docs

We have a pediatric GI doc who is very fond of ordering MBS’s (and every other test possible). In the last 5 years he has practiced at this hospital I have seen 4 of his patients actually aspirate. Most already have a dx of reflux. Because I work IP and do not do a ton of long-term feeding tx I was wondering if these MBS’s are helping anyone – particularly OP SLP’s who treat.

Answer: I think the GI docs are actually asking us to help them complete a differential, that is, to rule out if s/s the child presents might be a true dysphagia. It may be that the etiology for the s/s is indeed GI-related, but I have had pediatric patients referred by GI docs for VFSS who have both a GI-related etiology and a true dysphagia co-occurring, and also those for whom the etiology is indeed only dysphagia, though it appeared GI-related prior to the VFSS. The physician’s thoughtful use of the VFSS to assist with a differential is good and should be welcomed by those of us who work with children who present feeding/swallowing problems. To the extent that a good differential is completed, by us and by the doc, our plan of care will be more appropriate. Even if a child does not aspirate, the information about the physiology of the swallow and any bolus mis-direction, and its etiology(ies), is useful information. As Bonnie Martin-Harris has said, “Aspiration or penetration is neither necessary nor sufficient for a swallowing impairment”, meaning the value of /data from a VFSS is far greater than just a pass/fail rating.

Leave a Reply