Skip to main content
SpringerLink
Log in

Pediatric Flexible Endoscopic Evaluation of Swallowing

  • Chapter
  • First Online:
Multidisciplinary Management of Pediatric Voice and Swallowing Disorders

Abstract

Flexible endoscopic evaluation of swallowing (FEES) has long been considered one of the gold standards for assessment of swallowing in both pediatric and adult populations (Hartnick et al. Ann Otol Rhinol Laryngol 109(11):996–999, 2000; Langmore. Dysphagia 32(1):27–38, 2017; Rao et al. J Appl Res 18:53–57, 2003). In both children and adults, FEES is used to evaluate the structure and function of the upper airway, secretion management, pharyngeal swallowing function, and effectiveness of strategies to improve the safety and efficiency of swallowing. In pediatric FEES, one must consider development, growth, and relative positions of the pharynx and larynx (Delaney and Arvedson. Dev Disabil Res Rev 14(2):105–117, 2008; Lieberman et al. Arch Oral Biol 46(2):117–128, 2001; Pohunek. Paediatr Respir Rev 5(1):2–8, 2004; Prakash and Johnny. J Pharm Bioallied Sci 7(Suppl 1):S55–S58, 2015). In addition, neurophysiologic maturation including primitive reflex integration, coordination of central pattern generator-mediated feeding/swallowing behaviors, and maturation of respiratory/swallow coordination must be well understood (Barlow. Curr Opin Otolaryngol Head Neck Surg 17(3):187–193, 2009). The purpose of this chapter is to describe the procedures and strategies unique to FEES in the pediatric population. Prioritization of exam goals, roles of team members, and strategies for obtaining an optimal exam are discussed. The parameters of the FEES exam are discussed from a pediatric perspective. Practical considerations for the pediatric FEES clinic and case studies highlighting FEES in various pediatric populations are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hartnick CJ, Miller C, Hartley BEJ, Willging JP. Pediatric fiberoptic endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2000;109(11):996–9.

    Article  CAS  Google Scholar 

  2. Langmore SE. History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years. Dysphagia. 2017;32(1):27–38.

    Article  PubMed  Google Scholar 

  3. Rao N, Brady SL, Chaudhuri G, Donzelli JJ, Wesling MW. Gold-standard? Analysis of the videofluoroscopic and fiberoptic endoscopic swallow examinations. J Appl Res. 2003;18:53–7.

    Google Scholar 

  4. Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev. 2008;14(2):105–17.

    Article  PubMed  Google Scholar 

  5. Lieberman DE, McCarthy RC, Hiiemae KM, Palmer JB. Ontogeny of postnatal hyoid and larynx descent in humans. Arch Oral Biol. 2001;46(2):117–28.

    Article  CAS  PubMed  Google Scholar 

  6. Pohunek P. Development, structure and function of the upper airways. Paediatr Respir Rev. 2004;5(1):2–8.

    Article  PubMed  Google Scholar 

  7. Prakash M, Johnny JC. Whats special in a child’s larynx? J Pharm Bioallied Sci. 2015;7(Suppl 1):S55–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Barlow SM. Central pattern generation involved in oral and respiratory control for feeding in the term infant. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):187–93.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Paul Willging J. Endoscopic evaluation of swallowing in children. Int J Pediatr Otorhinolaryngol. 1995. https://doi.org/10.1177/000348940010901102.

    Article  CAS  Google Scholar 

  10. Leder SB. Serial fiberoptic endoscopic swallowing evaluations in the management of patients with dysphagia. Arch Phys Med Rehabil. 1998;79(10):1264–9.

    Article  CAS  PubMed  Google Scholar 

  11. Willette S, Molinaro LH, Thompson DM, Schroeder JW. Fiberoptic examination of swallowing in the breastfeeding infant. Laryngoscope. 2016;126(7):1681–6.

    Article  PubMed  Google Scholar 

  12. Reynolds J, Carroll S, Sturdivant C. Fiberoptic endoscopic evaluation of swallowing: a multidisciplinary alternative for assessment of infants with dysphagia in the neonatal intensive care unit. Adv Neonatal Care. 2016;16(1):37–43.

    Article  PubMed  Google Scholar 

  13. Suterwala MS, Reynolds J, Carroll S, Sturdivant C, Armstrong ES. Using fiberoptic endoscopic evaluation of swallowing to detect laryngeal penetration and aspiration in infants in the neonatal intensive care unit. J Perinatol. 2017;37(4):404–8.

    Article  CAS  PubMed  Google Scholar 

  14. Kelly AM, Leslie P, Beale T, Payten C, Drinnan MJ. Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity? Clin Otolaryngol. 2006;31(5):425–32.

    Article  CAS  PubMed  Google Scholar 

  15. Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117(10):1723–7.

    Article  PubMed  Google Scholar 

  16. Pisegna JM, Langmore SE. Parameters of instrumental swallowing evaluations: describing a diagnostic dilemma. Dysphagia. 2016;31(3):462–72.

    Article  PubMed  Google Scholar 

  17. Aviv JE, Kaplan ST, Thomson JE, Spitzer J, Diamond B, Close LG. The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations. Dysphagia. 2000;15(1):39–44. Winter.

    Article  CAS  PubMed  Google Scholar 

  18. Khoshoo V, Edell D. Previously healthy infants may have increased risk of aspiration during respiratory syncytial viral bronchiolitis. Pediatrics. 1999;104(6):1389–90.

    Article  CAS  PubMed  Google Scholar 

  19. Wilmott R, Bush A, Deterding R, Ratjen F, Sly P, Zar H, et al. Kendig’s disorders of respiratory tract in children. 9th ed. Philadelphia: Elsevier, Inc; 2017.

    Google Scholar 

  20. Miller CK, Willging JP. The implications of upper-airway obstruction on successful infant feeding. Semin Speech Lang. 2007;28(3):190–203.

    Article  PubMed  Google Scholar 

  21. Marvin S, Gustafson S, Thibeault S. Detecting aspiration and penetration using FEES with and without food dye. Dysphagia. 2016;31(4):498–504.

    Article  PubMed  Google Scholar 

  22. Leder SB, Acton LM, Lisitano HL, Murray JT. Fiberoptic endoscopic evaluation of swallowing (FEES) with and without blue-dyed food. Dysphagia. 2005;20(2):157–62. Spring.

    Article  PubMed  Google Scholar 

  23. Curtis J, Perry S, Troche M. Detection of airway invasion during FEES: comparing barium, blue dye, and green dye. Am J Speech-Lang Pathol. 2019;28(4):1–6.

    Google Scholar 

  24. Thakkar P, Arora K, Goyal K, Das RR, Javadekar B, Aiyer S, et al. To evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborns undergoing minor painful procedure: a randomized controlled trial. J Perinatol. 2016;36(1):67–70.

    Article  CAS  PubMed  Google Scholar 

  25. Redstone F, West JF. The importance of postural control for feeding. Pediatr Nurs. 2004;30(2):97–100.

    PubMed  Google Scholar 

  26. Flatters I, Mushtaq F, Hill LJB, Holt RJ, Wilkie RM, Mon-Williams M. The relationship between a child’s postural stability and manual dexterity. Exp Brain Res. 2014;232(9):2907–17.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Case-Smith J, Fisher AG, Bauer D. An analysis of the relationship between proximal and distal motor control. Am J Occup Ther Off Publ Am Occup Ther Assoc. 1989;43(10):657–62.

    Article  CAS  Google Scholar 

  28. van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TWJ, L’Hoir MP. Swaddling: a systematic review. Pediatrics. 2007;120(4):e1097–106.

    Article  PubMed  Google Scholar 

  29. Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev. 2008;84(7):441–9.

    Article  PubMed  Google Scholar 

  30. Evidence-Based Practice Briefs. 2018. Available from: https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

  31. Stolovitz P, Gisel EG. Circumoral movements in response to three different food textures in children 6 months to 2 years of age. Dysphagia. 1991;6(1):17–25.

    Article  CAS  PubMed  Google Scholar 

  32. Dunn W. Supporting children to participate successfully in everyday life by using sensory processing knowledge. Infants Young Child. 2007;20(2):84–101.

    Article  Google Scholar 

  33. Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia. 1996;11(2):99–103. Spring.

    Article  CAS  PubMed  Google Scholar 

  34. Vetter-Laracy S, Osona B, Roca A, Peña-Zarza JA, Gil JA, Figuerola J. Neonatal swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES). Pediatr Pulmonol. 2018;53(4):437–42.

    Article  PubMed  Google Scholar 

  35. Link DT, Willging JP, Cotton RT, Miller CK, Rudolph CD. Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative. Ann Otol Rhinol Laryngol. 2000;109(10 Pt 1):899–905.

    Article  CAS  PubMed  Google Scholar 

  36. Neubauer PD, Hersey DP, Leder SB. Pharyngeal residue severity rating scales based on fiberoptic endoscopic evaluation of swallowing: a systematic review. Dysphagia. 2016;31(3):352–9.

    Article  PubMed  Google Scholar 

  37. Neubauer PD, Rademaker AW, Leder SB. The Yale pharyngeal residue severity rating scale: an anatomically defined and image-based tool. Dysphagia. 2015;30(5):521–8.

    Article  PubMed  Google Scholar 

  38. Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293–314.

    Article  PubMed  Google Scholar 

  39. Boesch RP, Balakrishnan K, Acra S. Structure and functions of pediatric Aerodigestive programs: a consensus statement. Pediatrics. 2018;141(3):e20171701.

    Article  PubMed  Google Scholar 

  40. Ulualp S, Brown A, Sanghavi R, Rivera-Sanchez Y. Assessment of laryngopharyngeal sensation in children with dysphagia. Laryngoscope. 2013;123(9):2291–5.

    Article  PubMed  Google Scholar 

  41. Giraldo-Cadavid LF, Burguete J, Rueda F, Galvis AM, Castaneda N, Arbulu M, et al. Accuracy of a laryngopharyngeal endoscopic esthesiometer (LPEER) for evaluating laryngopharyngeal mechanosensitivity: a validation study in a prospectively recruited cohort of patients. Dysphagia. 2018;33(1):15–25.

    Article  PubMed  Google Scholar 

  42. Nienstedt JC, Müller F, Nießen A, Fleischer S, Koseki JC, Flügel T, et al. Narrow band imaging enhances the detection rate of penetration and aspiration in FEES. Dysphagia. 2017;32(3):443–8.

    Article  PubMed  Google Scholar 

  43. Fleischer S, Pflug C, Hess M. High-sensitivity FEES with NBI-illumination. Laryngoscope. 2017;127(5):1140–2.

    Article  PubMed  Google Scholar 

  44. Aghdam MA, Ogawa M, Iwahashi T, Hosokawa K, Kato C, Inohara H. A comparison of visual recognition of the laryngopharyngeal structures between high and standard frame rate videos of the Fiberoptic endoscopic evaluation of swallowing. Dysphagia. 2017;32(5):617–25.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Audiology, Speech and Learning, Children’s Hospital Colorado, Aurora, CO, USA

    Jennifer L. Maybee & Bridget M. Harrington

  2. Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO, USA

    Jeremy D. Prager

  3. Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA

    Jeremy D. Prager

Authors
  1. Jennifer L. Maybee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bridget M. Harrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeremy D. Prager
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer L. Maybee .

Editor information

Editors and Affiliations

  1. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    J. Scott McMurray

  2. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Matthew R. Hoffman

  3. Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Maia N. Braden

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Maybee, J.L., Harrington, B.M., Prager, J.D. (2020). Pediatric Flexible Endoscopic Evaluation of Swallowing. In: McMurray, J., Hoffman, M., Braden, M. (eds) Multidisciplinary Management of Pediatric Voice and Swallowing Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-26191-7_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26191-7_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26190-0

  • Online ISBN: 978-3-030-26191-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation