Pediatric emergency medicine trisk 1107 1107
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standard BS or upper gastrointestinal (UGI) series in that it does not use pure
contrast, but instead uses food mixed with contrast in an attempt to simulate the
normal feeding pattern as closely as possible. VFSS is less effective than a UGI
series or BS at diagnosing gastroesophageal reflux or lower esophageal, gastric
outlet, and small bowel abnormalities ( Fig. 56.3 ), but it is superior in identifying
pre-esophageal causes of dysphagia.
Fiberoptic endoscopic evaluation of swallowing (FEES) has also been used as
the diagnostic and clinical tool for the pediatric dysphagia patient. With a
nasopharyngeal approach under local anesthesia, FEES allows direct visualization
of the swallowing process with the ability to document aspiration and functional
pharyngeal or upper esophageal disorders. FEES may also be indicated for the
suspected mass lesion, stricture, caustic ingestion, inflammatory lesion, or foreign
body. FEES has been successfully used to initially screen dysphagia patients, and
to reevaluate swallowing function after feeding interventions to patient diet and
position, as well as food presentation. Fiberoptic endoscopic evaluation of
swallowing with sensory testing (FEESST) is a modification of FEES and is a test
of the laryngeal adductor response (LAR) and vocal cord dynamics for
assessment of the motor and sensory phases of swallowing. It is an alternative test
to VFSS with the benefits of being nonradioactive and can be done in the office
setting. This test is especially useful in decreasing aspiration pneumonia by
dietary and behavioral management of patients with swallowing problems.
Other tests, such as a complete blood cell count and blood, urine or CSF
cultures in the febrile patient, or blood gas for the patient with respiratory
distress, may also be indicated. Cervical ultrasonography has been used to
identify abnormalities with the tissues and function of the palate, tongue, and
floor of the mouth; however, it is less useful than contrast studies for assessing
airway problems and aspiration.
