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BaByVFSSImP© A Novel Measurement Tool for Videofluoroscopic Assessment of Swallowing Impairment in Bottle-Fed Babies: Establishing a Standard

  • Bonnie Martin-HarrisEmail author
  • Kathryn A. Carson
  • Jeanne M. Pinto
  • Maureen A. Lefton-Greif
Original Article



This investigation tested the construct validity of the first standardized assessment tool, the BaByVFSS Impairment Profile, (BaByVFSSImP©), developed for the quantification of swallowing observations made from videofluoroscopic swallow studies (VFSS) in bottle-fed babies.


Construct validity of the measures was tested using descriptive methods and confirmatory factor analysis (CFA) of swallowing scores obtained from a cohort of bottle-fed babies (median age 3 months 1 day, interquartile range 1 month 4 days–7 months 4 days) sequentially referred for VFSS based on clinical signs, symptoms, or risk factors associated with dysphagia and/or aspiration. Main outcome measures were emergence of functional domains derived from swallowing component impairment scores.


Confirmatory factor analysis resulted in 21 significant components (factor loadings ≥ 0.5) grouping into five functional domains labeled for common contribution to overall swallowing function. The tool was organized into the BaByVFSSImP. Clinical relevance was explored using correlational analyses between domain scores, maximum penetration/aspiration scores, feeding status, and caregiver burden.


Quantification of physiologic swallowing impairment captured by BaByVFSSImP holds promise for identification of physiologically based targets for intervention, clinical decisions regarding enteral feeding, and tracking the trajectory of swallowing impairment throughout development in young children.


Infant VFSS MBS Reliability Dysphagia Deglutition Deglutition disorders 



The authors wish to thank the families for partaking in this project. Our gratitude is expressed for the contributions of the Speech Language Pathologists that were involved in this work including Kate Davidson, M.S., M. Cara Erskine, M. Ed., Jeannine Hoch, M.A., Sandra B. Martin, M.S., Heather Mcghee, M.S., Katlyn McGrattan, Ph.D., Keeley McKelvey, M.S., and Melissa Montiel, M.S. This work was supported by the National Institutes of Health Grants NIDCD 5R01DC011290-05 (ML-G and BM-H). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  1. 1.
    Bhattacharyya N. The prevalence of pediatric voice and swallowing problems in the United States. Laryngoscope. 2015;125:746–50.CrossRefGoogle Scholar
  2. 2.
    Horton J, Atwood C, Gnagi S, Teufel R, Clemmens C. Temporal trends of pediatric Dysphagia in hospitalized patients. Dysphagia. 2018;33(5):655–61.CrossRefGoogle Scholar
  3. 3.
    Zimmerman E, Rosner A. Preterm infants are more at-risk for feeding-swallowing difficulties in the first three years of life. J Neonatal Nurs. 2018;24:331–5.CrossRefGoogle Scholar
  4. 4.
    Cerro N, Zeunert S, Simmer K, Daniels L. Eating behaviour of children 1.5–3.5 years born preterm: parents’ perceptions. J Paediatr Child Health. 2002;38:72–8.CrossRefGoogle Scholar
  5. 5.
    Arvedson JC. Food for thought on pediatric feeding and swallowing. Perspect Swallowing Swallowing Disord (Dysphagia). 2008;17:110–8.CrossRefGoogle Scholar
  6. 6.
    Lefton-Greif MA. Pediatric dysphagia. Phys Med Rehabil Clin N Am. 2008;19:837–51.CrossRefGoogle Scholar
  7. 7.
    Manikam R, Perman JA. Pediatric feeding disorders. J Clin Gastroenterol. 2000;30:34–46.CrossRefGoogle Scholar
  8. 8.
    Lefton-Greif MA, Okelo SO, Wright JM, Collaco JM, McGrath-Morrow SA, Eakin MN. Impact of children’s feeding/swallowing problems: validation of a new caregiver instrument. Dysphagia. 2014;29:671–7.CrossRefGoogle Scholar
  9. 9.
    Borowitz KC, Borowitz SM. Feeding problems in infants and children: assessment and etiology. Pediatr Clin North Am. 2018;65:59–72.CrossRefGoogle Scholar
  10. 10.
    Field D, Garland M, Williams K. Correlates of specific childhood feeding problems. J Paediatr Child Health. 2003;39:299–304.CrossRefGoogle Scholar
  11. 11.
    Rommel N, De Meyer AM, Feenstra L, Veereman-Wauters G. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003;37:75–84.CrossRefGoogle Scholar
  12. 12.
    Malas K, Trudeau N, Chagnon M, McFarland DH. Feeding-swallowing difficulties in children later diagnosed with language impairment. Dev Med Child Neurol. 2015;57:872–9.CrossRefGoogle Scholar
  13. 13.
    Adams-Chapman I, Bann C, Carter S, Stoll B, Network N. Language outcomes among ELBW infants in early childhood. Early Hum Dev. 2015;91:373–89.CrossRefGoogle Scholar
  14. 14.
    Wolthuis-Stigter MI, Da Costa SP, Bos AF, Krijnen WP, Van Der Schans CP, Luinge MR. Sucking behaviour in infants born preterm and developmental outcomes at primary school age. Dev Med Child Neurol. 2017;59(8):871–7.CrossRefGoogle Scholar
  15. 15.
    Hayden LP, Hobbs BD, Cohen RT, Wise RA, Checkley W, Crapo JD, Hersh CP, Investigators CO. Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study. Respir Res. 2015;16:115.CrossRefGoogle Scholar
  16. 16.
    Wiedmeier JE, Joss-Moore LA, Lane RH, Neu J. Early postnatal nutrition and programming of the preterm neonate. Nutr Rev. 2011;69:76–82.CrossRefGoogle Scholar
  17. 17.
    Joss-Moore LA, Lane RH. The developmental origins of adult disease. Curr Opin Pediatr. 2009;21:230–4.CrossRefGoogle Scholar
  18. 18.
    Hiorns MP, Ryan MM. Current practice in paediatric videofluoroscopy. Pediatr Radiol. 2006;36:911–9.CrossRefGoogle Scholar
  19. 19.
    Martin-Harris B, Humphries K, Garand KLF. The modified barium swallow impairment profile (MBSImP™)–innovation, dissemination and implementation. Perspect ASHA Spec Interest Groups. 2017;2(13):129–38.CrossRefGoogle Scholar
  20. 20.
    Norther Speech Services (NSS): Modified barium swallow impairment profile. 2017.
  21. 21.
    Lefton-Greif MA, McGrattan KE, Carson KA, Pinto JM, Wright JM, Martin-Harris B. First steps towards development of an instrument for the reproducible quantification of oropharyngeal swallow physiology in bottle-fed children. Dysphagia. 2018;33:76–82.CrossRefGoogle Scholar
  22. 22.
    Strauss K. ALARA in pediatric fluoroscopy. J Am Coll Radiol. 2007;4:931–3.CrossRefGoogle Scholar
  23. 23.
    Strauss K, Kaste S. ALARA in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients—a white paper executive summary. J Am Coll Radiol. 2006;3:686–8.CrossRefGoogle Scholar
  24. 24.
    National Guideline Clearinghouse (NGC): ACR-SPR practice guideline for the performance of contrast esophagrams and upper gastrointestinal examinations in infants and children. American College of Radiology (ACR): Agency for Healthcare Research and Quality (AHRQ), 2015.Google Scholar
  25. 25.
    Fordham L. Imaging of the esophagus in children. Radiol Clin North Am. 2005;43:283–302.CrossRefGoogle Scholar
  26. 26.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.CrossRefGoogle Scholar
  27. 27.
    Fracchia MS, Diercks G, Yamasaki A, Hersh C, Hardy S, Hartnick M, Hartnick C. Assessment of the feeding swallowing impact survey as a quality of life measure in children with laryngeal cleft before and after repair. Int J Pediatr Otorhinolaryngol. 2017;99:73–7.CrossRefGoogle Scholar
  28. 28.
    Arvedson JC, Lefton-Greif MA. Pediatric videofluoroscopic swallow studies: a professional manual with caregiver guidelines. San Antonio: Communication Skill Builders/Psychological Corporation; 1998.Google Scholar
  29. 29.
    Newman LA, Keckley C, Petersen MC, Hamner A. Swallowing function and medical diagnoses in infants suspected of Dysphagia. Pediatrics. 2001;108:E106.CrossRefGoogle Scholar
  30. 30.
    Martin-Harris B: MBSImP™ Web Based Learning Module. Northern Speech Services, 2017.Google Scholar
  31. 31.
    Martin-Harris B: The MBSImP Guide.: Northern Speech Services, 2018.Google Scholar
  32. 32.
    Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23:392–405.CrossRefGoogle Scholar
  33. 33.
    Brenner MH, Curbow B, Legro MW. The proximal-distal continuum of multiple health outcome measures: the case of cataract surgery. Med Care. 1995;33:As236–44.Google Scholar
  34. 34.
    McHorney CA, Martin-Harris B, Robbins J, Rosenbek J. Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia. 2006;21:141–8.CrossRefGoogle Scholar
  35. 35.
    Garand KLF, Armeson KE, Hill EG, Martin-Harris B. Identification of phenotypic patterns of Dysphagia: a proof of concept study. Am J Speech-Lang Pathol. 2018;27:988–95.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Communication Sciences and Disorders, Department of Otolaryngology Head and Neck Surgery, Department of Radiation Oncology, School of Communication, Feinberg School of MedicineNorthwestern UniversityEvanstonUSA
  2. 2.Department of Otolaryngology Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, College of MedicineMedical University of South CarolinaCharlestonUSA
  3. 3.Research ServiceEdward Hines, Jr. VA HospitalHinesUSA
  4. 4.Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthWelch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreUSA
  5. 5.Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Eudowood Division of Pediatric Respiratory Sciences, Department of PediatricsThe Johns Hopkins University School of Medicine, David M. Rubenstein BuildingBaltimoreUSA
  7. 7.Eudowood Division of Pediatric Respiratory Sciences, Department of PediatricsThe Johns Hopkins University School of Medicine, David M. Rubenstein BuildingBaltimoreUSA
  8. 8.Department of Otolaryngology-Head and Neck SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA
  9. 9.Department of Physical Medicine and RehabilitationThe Johns Hopkins University School of MedicineBaltimoreUSA

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