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.
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Data Availability
The datasets generated analysed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
The author would like to thank the following people for their support and advice for this study. Goh Siew Li for conceiving the original idea of the study and her support and advice throughout the study process. Tan Man Ling Stacy for her advice with the methodology and manuscript. Leo Wei Zhi for her advice with the methodology. Ong Chengsi for her advice with the manuscript. The KKH Speech Language Therapy Service for supporting this study. All the participants and their parents/guardians for their time in participating in this study.
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This study was approved by the SingHealth Centralised Institutional Review Board. It took place in Singapore and informed consent for participation in the study was obtained from all participants.
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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).
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Mok, X.T.J. The 100 ml-Timed Water Swallow Test: Pilot Data from Children with No Dysphagia. Dysphagia (2024). https://doi.org/10.1007/s00455-023-10664-0
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DOI: https://doi.org/10.1007/s00455-023-10664-0