Abstract
Aim
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.
Method
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.
Results
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.
Interpretation
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.
Similar content being viewed by others
References
Bhattacharyya N. The prevalence of pediatric voice and swallowing problems in the United States. Laryngoscope. 2015;125:746–50.
Horton J, Atwood C, Gnagi S, Teufel R, Clemmens C. Temporal trends of pediatric Dysphagia in hospitalized patients. Dysphagia. 2018;33(5):655–61.
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.
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.
Arvedson JC. Food for thought on pediatric feeding and swallowing. Perspect Swallowing Swallowing Disord (Dysphagia). 2008;17:110–8.
Lefton-Greif MA. Pediatric dysphagia. Phys Med Rehabil Clin N Am. 2008;19:837–51.
Manikam R, Perman JA. Pediatric feeding disorders. J Clin Gastroenterol. 2000;30:34–46.
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.
Borowitz KC, Borowitz SM. Feeding problems in infants and children: assessment and etiology. Pediatr Clin North Am. 2018;65:59–72.
Field D, Garland M, Williams K. Correlates of specific childhood feeding problems. J Paediatr Child Health. 2003;39:299–304.
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.
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.
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.
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.
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.
Wiedmeier JE, Joss-Moore LA, Lane RH, Neu J. Early postnatal nutrition and programming of the preterm neonate. Nutr Rev. 2011;69:76–82.
Joss-Moore LA, Lane RH. The developmental origins of adult disease. Curr Opin Pediatr. 2009;21:230–4.
Hiorns MP, Ryan MM. Current practice in paediatric videofluoroscopy. Pediatr Radiol. 2006;36:911–9.
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.
Norther Speech Services (NSS): Modified barium swallow impairment profile. https://www.mbsimp.com 2017.
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.
Strauss K. ALARA in pediatric fluoroscopy. J Am Coll Radiol. 2007;4:931–3.
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.
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.
Fordham L. Imaging of the esophagus in children. Radiol Clin North Am. 2005;43:283–302.
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.
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.
Arvedson JC, Lefton-Greif MA. Pediatric videofluoroscopic swallow studies: a professional manual with caregiver guidelines. San Antonio: Communication Skill Builders/Psychological Corporation; 1998.
Newman LA, Keckley C, Petersen MC, Hamner A. Swallowing function and medical diagnoses in infants suspected of Dysphagia. Pediatrics. 2001;108:E106.
Martin-Harris B: MBSImP™ Web Based Learning Module. Northern Speech Services, 2017.
Martin-Harris B: The MBSImP Guide.: Northern Speech Services, 2018.
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.
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.
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.
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.
Acknowledgements
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Martin-Harris, B., Carson, K.A., Pinto, J.M. et al. BaByVFSSImP© A Novel Measurement Tool for Videofluoroscopic Assessment of Swallowing Impairment in Bottle-Fed Babies: Establishing a Standard. Dysphagia 35, 90–98 (2020). https://doi.org/10.1007/s00455-019-10008-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00455-019-10008-x