Study population
A total of 128 children were referred for VFSS over the study period. As shown in Figure 2, 113 children underwent VFSS successfully. Their median age was 2.2 years (range 0.1-17.9). Forty-six of 113 (41%) had oropharyngeal aspiration, 9 (8%) overt and 37 (33%) silent, while 67 (59%) showed no evidence of aspiration.
At the time of VFSS, 39 (35%) of children were fed enterally to some degree; 8 gastrostomy, 2 gastro-jejunal or naso-jejunal, 1 nasogastric, and 28 mixed oral and enteral. The remaining children were fed orally. No child had a tracheostomy.
Background medical conditions by organ systems mainly affected, with a breakdown into more specific medical diagnoses of interest are shown in table 2. The great majority of children, 98 out of 113 (87%) had cardio-pulmonary involvement, reflecting the high proportion of children with clinical aspiration lung disease, 87 (77%) and congenital heart disease, 42 (37%). The latter almost never occurred in isolation, being associated with at least one of the other medical diagnoses in 39 out of 42 (93%) cases. Our population was further characterized by a high frequency of gastro-intestinal, 73 (64%) and neurological involvement, 68 (60%), indicating a high prevalence of complex developmental disorders, such as genetic syndromes and cerebral palsy, often resulting in dysphagia. The structural group included children with cleft palate, laryngeal cleft and tracheo-esophageal fistula.