The 100 ml-Timed Water Swallow Test: Pilot Data from Children with No Dysphagia

Abstract

Dysphagia screening tests are useful in identifying possible dysphagia for further evaluation and in supporting feeding recommendations. This study aimed to investigate swallowing parameters in children, while widening the pool of data available, using the ‘100 ml-Timed Water Swallow Test’ (100 ml-TWST). Sixty Singaporean children aged 4 to 18 years old completed the 100 ml-TWST via a cup and a straw. Task completion, presence of cough, choke or throat clear, post-swallow voice quality, total time taken and number of swallows were observed. Subsequently, analysis of time per swallow (T/S), volume per swallow (V/S) and volume per time or swallowing capacity (V/T) were performed. Higher tendencies for coughing and task incompletion were observed in younger participants. A shorter time taken, fewer number of swallows, greater V/S and greater swallowing capacity were observed for adolescent or male participants, or via the mode of cup drinking. These could be due to oropharyngeal structural changes and swallow maturation with age, an increased capacity of oropharyngeal structures for swallowing in adolescent males, and more controlled or paced drinking from a straw. A plateau in time taken, number of swallows and swallowing capacity in adolescence were also observed, possibly indicating an emerging maturation of swallow functions during that period. Interestingly, speed of bolus movement was largely unaffected by age, gender and mode of drinking. Pilot data for children with no dysphagia have been established, while gaining insight into the swallowing parameters and maturation process in the paediatric population.

Appendices

Appendix 1: Performance of Participants for Observed Variables (Completion of the TWSTs, Presence of Coughing, Choking, Throat Clearing or Gagging and Post-trial Voice Quality), Stratified by Age, Mode of Drinking and Gender

Incompletion of 100 ml-TWST

Age (years)	Gender	Total number	Number incomplete
			Cup	Straw
4–6	Male	5	3	3
	Female	7	–	–
7–9	Male	8	–	–
	Female	4	–	–
10–12	Male	7	–	–
	Female	5	–	–
13–15	Male	7	1	1
	Female	5	–	–
16–18	Male	5	–	–
	Female	7	–	–
Total number		60	4	4

Presence of Cough, Choke, Throat Clear or Gag

Age (years)	Gender	Total number	Cup	Straw
4–6	Male	5	2	–
	Female	7	1	–
7–9	Male	8	–	–
	Female	4	–	–
10–12	Male	7	–	–
	Female	5	–	–
13–15	Male	7	–	–
	Female	5	–	–
16–18	Male	5	–	–
	Female	7	1	–
Total number		60	4	0

Post-trial Voice Quality

Age (years)	Gender	Total number	Voice quality change in baseline post-trial
			Cup	Straw
4–6	Male	5	–	–
	Female	7	–	–
7–9	Male	8	–	–
	Female	4	–	–
10–12	Male	7	–	–
	Female	5	–	–
13–15	Male	7	–	–
	Female	5	–	–
16–18	Male	5	–	–
	Female	7	–	–
Total number		60	0	0

Appendix 2: Performance of Participants for Time Taken, Number of Swallows, T/S, V/S and V/T (Swallowing Capacity), Stratified by Age, Mode of Drinking and Gender

Time Taken (s)

Age (years)	Gender	Cup			Straw
		Mean	SD	Min–Max	Mean	SD	Min–Max
4–6	Male	16.61	10.76	9.00–24.22	21.61	12.79	12.56–30.65
	Female	34.09	25.11	10.18–78.38	50.94	56.33	14.84–172.94
7–9	Male	12.80	8.27	6.03–27.47	16.53	8.40	9.57–34.87
	Female	22.65	6.76	14.91–30.44	27.95	18.13	17.50–54.97
10–12	Male	10.40	5.88	5.22–21.22	17.68	16.01	6.10–52.50
	Female	17.76	4.51	13.63–23.56	29.48	15.32	17.50–55.58
13–15	Male	6.82	1.97	4.72–8.94	10.32	2.85	7.19–14.06
	Female	8.24	3.42	5.81–14.15	12.03	2.34	10.32–16.00
16–18	Male	6.62	2.32	4.32–10.15	10.24	2.42	7.31–13.81
	Female	7.89	2.32	6.06–11.72	11.65	2.63	8.63–16.09

Number of Swallows

Age (years)	Gender	Cup			Straw
		Mean	SD	Min–Max	Mean	SD	Min–Max
4–6	Male	14.50	9.19	8.00–21.00	8.50	0.71	8.00–9.00
	Female	17.29	9.43	7.00–31.00	18.71	11.31	7.00–38.00
7–9	Male	7.38	3.62	4.00–15.00	9.00	1.85	6.00–11.00
	Female	12.25	0.96	11.00–13.00	15.50	6.86	10.00–25.00
10–12	Male	5.57	1.72	3.00–8.00	7.43	2.99	3.00–12.00
	Female	9.20	2.59	5.00–12.00	12.40	5.77	7.00–22.00
13–15	Male	5.00	2.19	2.00–8.00	7.83	3.43	5.00–14.00
	Female	4.60	1.14	3.00–6.00	6.60	1.94	5.00–10.00
16–18	Male	3.40	0.89	2.00–4.00	4.60	1.82	3.00–7.00
	Female	5.71	1.38	4.00–8.00	8.43	2.44	5.00–11.00

T/S (s)

Age (years)	Gender	Cup			Straw
		Mean	SD	Min–Max	Mean	SD	Min–Max
4–6	Male	1.14	0.14	1.13–1.15	2.62	1.721	1.40–3.83
	Female	1.93	0.93	1.20–3.79	2.44	1.30	1.34–4.55
7–9	Male	1.68	0.48	1.13–2.75	1.82	0.74	1.24–3.49
	Female	1.85	0.53	1.36–2.54	1.76	0.53	1.09–2.20
10–12	Male	1.77	0.49	1.18–2.65	2.19	1.08	1.22–4.38
	Female	2.01	0.51	1.51–2.73	2.46	0.84	1.53–3.54
13–15	Male	1.54	0.65	1.03–2.66	1.42	0.44	1.00–2.22
	Female	1.82	0.64	1.21–2.83	1.94	0.63	1.08–2.67
16–18	Male	2.04	0.82	1.25–3.38	2.61	1.45	1.40–4.60
	Female	1.42	0.45	0.91–2.34	1.45	0.39	0.99–1.91

V/S (ml)

Age (years)	Gender	Cup			Straw
		Mean	SD	Min–Max	Mean	SD	Min–Max
4–6	Male	8.63	5.47	4.76–12.50	11.81	0.98	11.11–12.50
	Female	7.59	4.26	3.23–14.29	7.38	4.44	2.63–14.29
7–9	Male	16.07	6.46	6.67–25.00	11.59	2.72	9.09–16.67
	Female	8.20	0.67	7.69–9.09	7.34	2.74	4.00–10.00
10–12	Male	19.78	7.23	12.50–33.33	16.11	8.46	8.33–33.33
	Female	11.89	4.64	8.33–20.00	9.31	3.57	4.55–14.29
13–15	Male	24.47	13.56	12.50–50.00	14.57	5.19	7.14–20.00
	Female	23.00	6.50	16.67–33.33	16.00	3.65	10.00–20.00
16–18	Male	31.67	10.87	25.00–50.00	24.52	8.97	14.29–33.33
	Female	18.35	4.20	12.50–25.00	12.89	4.23	9.09–20.00

V/T / Swallowing Capacity (ml/s)

Age (years)	Gender	Cup			Straw
		Mean	SD	Min–Max	Mean	SD	Min–Max
4–6	Male	7.62	4.94	4.13–11.11	5.61	3.32	3.26–7.96
	Female	4.62	3.12	1.28–9.82	3.73	2.36	0.58–6.74
7–9	Male	10.31	4.72	3.64–16.58	7.07	2.47	2.87–10.45
	Female	4.75	1.50	3.29–6.71	4.46	1.84	1.82–5.71
10–12	Male	12.30	5.99	4.71–19.16	8.73	4.96	1.90–16.39
	Female	5.92	1.44	4.24–7.34	3.99	1.52	1.80–5.71
13–15	Male	15.75	4.55	11.19–21.19	10.32	2.78	7.11–13.91
	Female	13.45	4.05	7.07–17.21	8.53	1.40	6.25–9.69
16–18	Male	16.53	5.27	9.85–23.15	10.20	2.39	7.24–13.68
	Female	13.54	3.48	8.53–16.50	8.94	1.85	6.22–11.59

Time taken, number of swallows, T/S, V/S and V/T/swallowing capacity were based only on participants who completed the 100 ml-TWST (i.e. incomplete trials were excluded).