Pediatric Flexible Endoscopic Evaluation of Swallowing

Abstract

Flexible endoscopic evaluation of swallowing (FEES) has long been considered one of the gold standards for assessment of swallowing in both pediatric and adult populations (Hartnick et al. Ann Otol Rhinol Laryngol 109(11):996-999, 2000; Langmore. Dysphagia 32(1):27-38, 2017; Rao et al. J Appl Res 18:53-57, 2003). In both children and adults, FEES is used to evaluate the structure and function of the upper airway, secretion management, pharyngeal swallowing function, and effectiveness of strategies to improve the safety and efficiency of swallowing. In pediatric FEES, one must consider development, growth, and relative positions of the pharynx and larynx (Delaney and Arvedson. Dev Disabil Res Rev 14(2):105-117, 2008; Lieberman et al. Arch Oral Biol 46(2):117-128, 2001; Pohunek. Paediatr Respir Rev 5(1):2-8, 2004; Prakash and Johnny. J Pharm Bioallied Sci 7(Suppl 1):S55-S58, 2015). In addition, neurophysiologic maturation including primitive reflex integration, coordination of central pattern generator-mediated feeding/swallowing behaviors, and maturation of respiratory/swallow coordination must be well understood (Barlow. Curr Opin Otolaryngol Head Neck Surg 17(3):187-193, 2009). The purpose of this chapter is to describe the procedures and strategies unique to FEES in the pediatric population. Prioritization of exam goals, roles of team members, and strategies for obtaining an optimal exam are discussed. The parameters of the FEES exam are discussed from a pediatric perspective. Practical considerations for the pediatric FEES clinic and case studies highlighting FEES in various pediatric populations are presented.