VIDEOFLUOROSCOPIC SWALLOW STUDY IN CHILDREN WITH DYSPHAGIA

Introduction and Pourpose Infancy and childhood represent a time of unparalleled physical growth and cognitive development. In order for infants and children to reach their linear and neurological growth potential, they must be able to reliably and safely consume sufficient energy and nutrients. The prevalence of feeding problems has been estimated to be from 33% to 80% in children with developmental disorders. Approximately 37% to 40% of children assessed for feeding and swallowing disorders were born prematurely at less than 37 weeks of gestation. Increased survival rates of children with histories of prematurity, low birth weights, and complex medical conditions might explain the recent increase of pediatric dysphagia. Premature surviving patients, chronic illness, and psychological conditions are all possible causes of dysphagia in children. Swallowing difficulties in pediatric populations can have an adverse impact on pulmonary health. Dysphagia in pediatric populations can have a detrimental effect on dietary intake and, thus, growth and development. As a result, it is imperative to accurately identify and appropriately manage dysphagia in pediatric populations. These complex patients require a multidisciplinary approach that includes clinical and instrumental evaluations. The videofluoroscopic swallow study (VFSS) is a well established radiological technique largely used in adult population. VFSS in children of a referral center for dysphagia is herein reported. 288 patients, mean age 9 years (range: 2-18) underwent VFSS. In 185 cases (64%) macro silent aspiration (fig.1-2) or macro silent aspiration and GERD (Fig. 3-4), was evident and patients scheduled for gastro/ digiunostomy and, if necessary, fundoplication (fig. 9,10,11,12); in 45 (16%) only micro silent aspiration (Fig. 5-6) or micro silent aspiration and GERD (Fig. 7-8), was detected and patients directed to a rehabilitation trial, and in 58 cases (20%) no aspiration and patients sent to speech therapist. No complications occurred, although in 6 cases (0,74%) VFSS could not be completed due to demonstration of massive aspiration. Results VFSS swallowing study was performed with personal protocol. Dysphagic patients, aged <18 years, referred to our center underwent VFSS as part of a multidisciplinary program. The VFSS images were assessed according to structural and functional findings in the oral, pharyngeal and esophageal-phase of the swallowing process. Criteria for VFSS included: risk of aspiration, prior aspiration pneumonia, clinical suspicion of pharyngeal/laryngeal problem, and husky voice. VFSS started with nectar viscosity and boluses of 1-2mL. If no radiological aspiration was confirmed, patients received boluses of increased density. Materials and methods VFSS Protocol Three consistencies: ØSemiliquid, ØSemisolid ØLiquid üMixed with barium sulfate (PRONTOBARIO HD 250% weight-volume Bracco, Milan, Italy) To the volume 1-2 cc (teaspoon); bottled milk Step 1 Semiliquid bolus: yogurt, barium and barium sulfate Step 2 Semisolid bolus: pudding and barium sulfate Step 3 Liquid bolus: water and barium sulfate v Administer at least two pains for consistency v Examination suspended when aspiration occurred Swallowing, Nutrition And Imaging – 9 th European Society Swallowing Disordes Congress, 19 – 21 Sep, Vienna 2019 üSwallowing difficulties can have a detrimental effect on pulmonary health and can also impact nutritional intake. üDue to the heterogeneity of the pediatric dysphagia population, treatment and management of dysphagia must be tailored to the clinical characteristics of the individual patient. üCommon instrumental assessment for children suspected of dysphagia includes videofluoroscopic swallow study and esophagram contrast study. üCommon management strategies include for children with oral-phase swallowing problems are aimed at improving the sensory and motor skills needed for drinking and eating, for children with swallowing problems affecting the pharyngeal phase, therapy generally involves modifying the child’s swallowing strategy or modifying the food bolus, for children with severe dysphagia are subjected to surgery for a therapeutic surgical device (gastrostomy, jejunostomy or laparoscopic fundoplication ). Correspondence to: stefano.doratiotto@aulss2.veneto.it Conclusions Like adults, infants and older children can present with swallowing difficulties. Unlike adults, children have rapidly developing body systems and even shortterm problems with swallowing can interrupt normal development and cause serious long-term sequelae. Therefore, accurate diagnosis and effective management of pediatric dysphagia is necessary due to its potential for significant morbidity and possible mortality in pediatric populations. VFSS is the gold standard for identifying inhalation episodes in dysphagic patients. It allows to evaluate the characteristic of swallowing, to determine the need of any nutritional devices and type of eating rehabilitation, and to monitor the progression of the underlying disease. VFSS must always be performed, even in children, before embarking on medical or surgical treatment