Catherine’s Research Corner: Facilitating Pediatric Patients During Videofluoroscopic Swallowing Studies

Catherine Shaker Seminars

2 years ago

The VFSS (videofluoroscopic swallowing study) requires a high level of clinical reasoning and critical thinking. Pediatric therapists utilizing best practice during videofluoroscopic swallow studies recognize that reading the x-ray images in-and-of-itself is insufficient for completing a differential, generating an impression and prescribing a plan of intervention. Multiple considerations are essential, including interpreting the radiographic data in the setting of that child’s unique history, comorbidities and and clinical presentation. Building on their previous publication Smith & Barkmeier-Kraemer, 2022, there are logistical considerations that the authors delineate to optimize clinical yield and plan of care.

Citation:

Smith, L. S., Brinker, K., Jones, C. E., Ray, M. H., Taylor, H. M., Gardiner, R. T., & Sauer, T. M. (2024). Facilitating Pediatric Patients During Videofluoroscopic Swallowing Studies. Perspectives of the ASHA Special Interest Groups, 9(4), 1119-1133.

Quoted from the Abstract:

Results/Conclusion:

Facilitative techniques during pediatric VFSS benefit the obtaining of accurate diagnostic results to guide pediatric feeding disorder management and recommendations.

The pediatric videofluoroscopic swallowing study (VFSS) is an imaging procedure that captures moving X-rays while infants or children swallow liquids or solids containing barium. The process allows evaluation of oral, pharyngeal, and upper esophageal function. The purpose of the study is to define swallowing function with the intent of designing appropriate care plans for patients with disordered swallowing, also known as dysphagia. The management of swallowing problems can be complex, as dysphagia exists within the larger context of pediatric feeding disorder (PFD; Goday et al., 2019). An accurate instrumental assessment of dysphagia through VFSS is a critical diagnostic study for many pediatric patients with PFD, and therefore crucial to the formulation of individualized and appropriate treatment plans.

Conducting a pediatric VFSS in a manner that accurately reveals swallowing pathophysiology can be challenging due to a variety of factors present in testing situations with infants and children. Arvedson and Lefton-Greif (1998) provide detailed information regarding the conducting of VFSS in their manual: Pediatric Videofluoroscopic Swallow Studies: A Professional Manual With Caregiver Guidelines. The American Speech-Language-Hearing Association (ASHA) Practice Portal provides guidance on conducting comprehensive assessment of feeding and swallowing disorders, including instrumental evaluations. Speech-language pathologists (SLPs) are instructed to conduct assessments in a “sensitive and responsive manner” (ASHA, n.d.), which implies support of the caregiver and patient throughout the evaluation process.

SLPs may facilitate inpatient and outpatient children ages birth through 18 years in multiple ways to increase the likelihood of obtaining an accurate and representative sample of swallowing during VFSS. Clinical efforts have revealed effective techniques for use during pediatric VFSS, to achieve studies of higher diagnostic value. These techniques are offered herein as applicable with various pediatric patients, dependent on SLP judgment. The Pediatric Videofluoroscopic Value Scale (pVFSS), a novel tool used to summarize a clinician’s level of trust in VFSS results, includes five categories (Smith & Barkmeier-Kraemer, 2022). Facilitative techniques for each of the five categories, namely, feeding engagement, crying, volume consumed, bolus size, and method, are discussed in this clinical focus article.