Clinical Feeding Evaluation and Videofluoroscopy: An Integrative
Approach to Feeding Management in Children with Suspected Aspiration
Background Video fluoroscopy swallow studies (VFSS) are considered gold
standard for the diagnosis of aspiration in children but require
resources and radiation compared to clinical feeding evaluation (CFE).
We evaluated their added value for diagnosis, feeding management and
clinical status. Methods A retrospective single-center cohort study of
children aged 0-18 years, referred for VFSS at a tertiary pediatric
hospital. Results 113 children, median age (range) 2.2 years (0.1-17.9)
successfully completed VFSS. Forty-six (41%) had oropharyngeal
aspiration, 9 (8%) overt alone and 37 (33%) including silent
aspirations. Underlying medical conditions included clinically suspected
aspiration lung disease (ALD), 87 (77%); neurologic disease, 73 (64%);
gastrointestinal disease, 73 (64%) and congenital heart disease, 42
(37%), not mutually exclusive. Those with ALD or cerebral palsy were
more likely to have aspiration by VFSS, OR 3.2 and 9.8 respectively.
Sensitivity and specificity of CFE for VFSS diagnosis of aspiration were
71% and 84% respectively. Feeding recommendations after VFSS differed
significantly from those based on prior CFE, p<0.001: The rate
of exclusively orally fed children increased from 65% to 79%, p=0.006
and exclusively enterally fed children from 10% to 14%; p=0.005.
During the following year, there were significantly less antibiotic
courses, as well as total and respiratory admissions. Conclusions In
this population of children with a high prevalence of clinically
suspected ALD, VFSS refined diagnosis and altered feeding management
compared to CFE, with subsequent clinical improvement.