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Twenty years of quantitative instrumental measures of swallowing in children: a systematic review

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Abstract

Early identification and intervention has shown better health outcomes for children with dysphagia. Instrumental swallowing assessments are vital and have been a focus of dysphagia research in the last two decades. This systematic review explores published quantitative instrumental measures of swallowing in children. Five subject-related databases were searched to identify original scientific articles published in English, using instrumental quantitative measures of swallowing to study swallowing/feeding mechanism in children since 1998. Two thousand two hundred and two articles were found from the initial database search and 36 were included in the final qualitative synthesis following PRISMA guidelines. Selected studies showed great diversity in target population, phase/s of swallowing studied, instrumentation used (n = 10) and quantitative measures reported (n = 144). Videofluoroscopy and manometry have been studied most repeatedly. With less frequency, a variety of other instruments has been used to describe suck-swallow patterns and swallowing-related respiration. High-resolution manometry shows the greatest increase in publications with validated, reliable quantitative measures of pharyngeal and oesophageal pressures and timing. More recently, quantification of videofluoroscopy analysis has been a focus.

Conclusion: A diverse range of quantitative measures of swallowing is available for children in the literature. However, further reliability and validity testing is needed. Opportunities for clinical application of these quantitative manometric and videofluoroscopic measures are restricted by limited normative comparisons and vast variability in published measures.

What is known?

• Instrumental swallowing assessments are reliable and accurate in diagnosing swallowing difficulties in children.

• However, subjective interpretation of observational findings often questions the optimal use of instrumentation.

What is new?

• High-resolution manometry has shown promising progress with the development of quantitative objective swallow measures for children. While attempts to quantify video-fluoroscopic measures have been increased in the recent past.

• A vast variety of instruments has been used to obtain quantitative and/or objective swallow measures of children, yet clinical application is still in progress.

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Abbreviations

DCA:

Digital cervical auscultation

EMG:

Electromyography

FEES:

Flexible endoscopic evaluation of swallowing

GRADE:

Grading of Recommendations, Assessment, Development, and Evaluation

HRIM:

High-resolution impedance manometry (HRIM)

LES:

Lower oesophageal sphincter

MBS:

Modified barium swallow

MBSImP™:

Modified Barium Swallow Impairment Profile

MM:

Manometry

MMAT:

Mixed Method Appraisal Tool

PAS:

Penetration Aspiration Scale

PES:

Pharyngo-oesophageal sphincter

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PT:

Pressure transducer

RIP:

Respiratory inductance plethysmography

UES:

Upper oesophageal sphincter

US:

Ultrasound

VFSS:

Videofluoroscopic study of swallowing

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Authors and Affiliations

  1. Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand

    Isuru Dharmarathna & Anna Miles

  2. Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka

    Isuru Dharmarathna

  3. Department of Surgery, The University of Auckland, Auckland, New Zealand

    Jacqui Allen

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  1. Isuru Dharmarathna
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  2. Anna Miles
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Contributions

Study concept and design: ID and AM. Acquisition of data: ID. Analysis and interpretation of data: ID, AM. Drafting the manuscript: ID. Critical revision of the manuscript for important intellectual content: AM, JA and ID. Final approval of the paper to be published: All authors. ID- study concept, design, literature search, data analysis, interpretation, drafting of manuscript and revision, final approval. AM- concept and design of the study, interpretation of data, revision and final approval of manuscript. JA- revision of manuscript and final approval.

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Correspondence to Isuru Dharmarathna.

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Communicated by Mario Bianchetti

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Table 7 Summary of the studies included in the systematic review
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Dharmarathna, I., Miles, A. & Allen, J. Twenty years of quantitative instrumental measures of swallowing in children: a systematic review. Eur J Pediatr 179, 203–223 (2020). https://doi.org/10.1007/s00431-019-03546-x

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