Parents of children with various medical problems often report that their children are also poor feeders. Upon obtaining a history from parents, clinicians frequently hear that there are characteristics and patterns that should cause one to suspect the existence of dysphagia. Dysphagia is defined as inability or difficulty in swallowing. The signs of a swallowing disorder may include: (1) frequent coughing or choking during or after eating and drinking; (2) a medical history which includes multiple episodes* of upper respiratory infections, pneumonia and ear* infections; (3) a wet sounding voice following meals; (4) changes in respiratory status during or after meals; (5) the need for multiple attempts at swallowing individual spoonfuls of food; (6) increased fatigue due to increased effort during feeding which may result in the child’s falling asleep during or after meals; and (7) weight loss. When these characteristics appear in a feeding history, they are the red flags* that indicate the need for further evaluation.
Cookie Swallow Study
The Swallowing Disorders Clinic provides a comprehensive assessment for children who are suspected of having swallowing disorder. The components of the assessment include the gathering of in-depth medical and feeding information in conjunction with a clinical feeding* observation. In addition, a Cookie Swallow Study is conducted in situations where physiological and anatomical information about the oral cavity and pharynx during swallowing of liquids and solids is required. During this radiologic study a speech-language pathologist and radiologist observe all phases of the swallow (oral-preparatory, oral, pharyngeal and cervical esophageal) and are able to identify difficulty in bolus* formation and control as well as aspiration.
The traditional name for this study is the Modified Barium Swallow, often confused with Barium Swallow, Upper GI or esophagram. The Upper GI is performed using a single contrast consistency with the patient in a supine* or prone position. The primary emphasis during the Upper GI is on the distal esophagus while the proximal esophagus is examined in greater detail during the Cookie Swallow Study. During the Cookie Swallow Study, the patient is in an upright position, viewed initially in the lateral plane. This position allows the medical team to observe how the child normally swallows as well as the role gravity plays in her swallow. Depending on the age and oral capability of the child, small amounts of some or all of the following textures are presented: a thin, liquid substance, a pudding like consistency, a thick paste and a solid material (a cookie) which requires mastication. The focus of this study is on the diagnosis of oral and pharyngeal dysphagia and the formulation of recommendations to improve the child’s ability to swallow or to reduce the risk of aspiration.
Following the assessment, recommendations are given to the child’s physicians, therapists and educators in the community. Recommendations often include suggestions for changes in the physical positioning of the child during feeding as well as dietary adjustments including alterations in food consistency or the elimination of specific food types that result in aspiration.
The Swallowing Disorders Clinic at was developed to provide a comprehensive evaluation of children who are suspected of having swallowing disorders. the clinic is a joint venture between the Department of Audiology and Communication Disorders and the Department of Radiology.