A swallow study for babies is a specialized diagnostic procedure that evaluates how infants safely and effectively consume liquids and solids. This assessment helps medical professionals understand the coordination of a baby’s mouth, throat, and esophagus during feeding. Its purpose is to identify any swallowing difficulties that could lead to health complications.
Reasons for a Baby’s Swallow Study
Several signs and symptoms can indicate that a baby might benefit from a swallow study. These include frequent coughing or choking during or after feeds, or recurrent spitting up. Poor weight gain or a failure to thrive despite regular feeding attempts can also suggest issues with nutrient intake due to swallowing problems. Recurrent respiratory infections, such as pneumonia or bronchiolitis, can indicate that food or liquid is entering the baby’s airway instead of the stomach. Prolonged feeding times, where meals take an unusually long duration, may also point to inefficiencies or difficulties in the swallowing process.
Different Types of Studies
When evaluating a baby’s swallowing, two primary instrumental studies are commonly utilized: the Modified Barium Swallow Study (MBSS), also known as a Videofluoroscopic Swallow Study (VFSS), and the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). The MBSS is an X-ray procedure where the baby swallows liquids and foods mixed with a small amount of barium, a contrast material that shows up on X-ray images. This allows a radiologist and speech-language pathologist to observe the entire swallowing process in real-time, from the mouth through the throat and into the esophagus, identifying any abnormalities. The MBSS helps to visualize whether food or liquid enters the airway, a condition known as aspiration.
Conversely, the FEES procedure involves a thin, flexible tube with a camera, called an endoscope, which is gently inserted through the baby’s nose and positioned in the throat. This allows direct visualization of the throat and voice box structures before and after the swallow, assessing how they move and protect the airway. Unlike the MBSS, FEES does not use radiation and can often be performed at the bedside in a hospital room or clinic setting. While MBSS provides a comprehensive view of the entire swallow, FEES offers a detailed look at the pharyngeal phase and can be particularly useful for assessing the larynx’s function during feeding.
What Happens During the Study
Preparation for a swallow study typically involves specific instructions from the medical team, such as withholding food or drink for a few hours before the appointment to ensure the baby is hungry and willing to eat during the assessment. Parents are often encouraged to bring the baby’s preferred bottles, cups, and foods from home to make the feeding environment as familiar and comfortable as possible. Upon arrival, the family will usually meet with a speech-language pathologist who will take a detailed history of the baby’s feeding habits and any concerns. The study itself takes place in a specialized setting, such as a radiology suite for an MBSS or a clinic room for a FEES, where the necessary equipment is present.
During the study, the baby will be positioned comfortably, often in a specialized chair or held by a caregiver, to mimic a typical feeding posture. The speech-language pathologist will present various consistencies of liquids and foods, sometimes mixed with barium for MBSS or dyed for FEES, observing the baby’s response. A radiologist will also be present for an MBSS to operate the X-ray equipment and capture images of the swallow. Caregivers are typically allowed to be present and often asked to feed their baby during the study, wearing a lead apron for radiation protection during an MBSS.
Understanding the Results and Next Steps
Following the swallow study, the speech-language pathologist and, for MBSS, the radiologist, will interpret the findings and discuss them with the parents. Common findings include aspiration, where food or liquid enters the airway and potentially the lungs, or penetration, where food or liquid enters the larynx but remains above the vocal cords. The study also assesses other issues such as oral phase difficulties, like problems with sucking or chewing, or pharyngeal phase issues, such as delayed swallow initiation or residue left in the throat after swallowing.
Based on the study’s results, the medical team will provide specific recommendations tailored to the baby’s needs. These may include modifying liquid thickness, such as using thickened formula or breast milk, or adjusting feeding techniques like pacing or positioning. Referrals to feeding therapy, typically with a speech-language pathologist or occupational therapist, are common to help the baby develop safer and more efficient feeding skills. In some instances, further medical evaluations or interventions may be recommended to address underlying conditions contributing to the swallowing difficulties.