The Feeding and Swallowing Program at Children's Hospital Colorado

Video fluoroscopic swallow studies (VFSS) are a radiographic assessment of feeding and swallowing. VFSS is used to address concerns about swallowing dysfunction and aspiration (when food, saliva and other materials are breathed into the airway).

What can we expect from a video fluoroscopic swallow study?

A visit for a video fluoroscopic swallow study is approximately 30 minutes to 1 hour long. A typical visit includes:

• Caregiver interview: A speech therapist andoccupational will meet with you and ask about your concerns for your child’s swallow function.
• Observation and radiology: You will then accompany your child into the radiology suite. While your child drinks and eats, a radiologist will take moving X-ray images. Your child may be asked to eat and drink different liquids and foods during the study.
• Results: After the team has completed the exam, they will share evaluation results with you and your child after the visit.
• Report: A detailed report is sent in the mail and via MyChart within one to two weeks of the visit.

Outpatient referrals: Your child will be referred for outpatient services if further evaluation or intervention is needed. To learn more, see this handout.

The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) Clinic is a collaborative effort between the Pediatric Otolaryngology Department and the Feeding and Swallowing Program. In the FEES Clinic, a multidisciplinary team of otolaryngologists (ear, nose and throat doctors), speech pathologists, occupational therapists and nursing personnel evaluate a child's feeding and swallowing skills. In this clinic, our team uses a fiberoptic endoscopic evaluation of swallowing (FEES), a small tube used to evaluate your child's swallowing or feeding.

What can we expect from a fiberoptic endoscopic evaluation of swallowing?

A visit to the outpatient FEES Clinic is approximately one hour long. A typical visit includes:

• Caregiver interview: Team members will ask about your child's medical history and your concerns regarding your child's feeding and swallowing.
• Observation: Team members will observe your child while eating and drinking.
  • A brief endoscopy procedure: During the FEES evaluation, the doctor places a flexible, narrow endoscope inside your child's nose. The doctor may ask your child to talk, cough, eat or drink with the scope in their nose. If your child eats or drinks, the food and liquid is dyed blue to help the evaluators see it easily on the screen. You and your child (if able) can observe the procedure as it is happening on a screen. The procedure lasts anywhere from less than a minute to approximately five minutes.
  • Results: The evaluating therapist will share evaluation results with you and your child after the visit. A brief report will be handed to you before you leave, including recommendations for the safest diet for your child.
  • Report: A more detailed report is sent in the mail within one to two weeks of the visit.
• Outpatient referral: Your child will be referred to outpatient nutrition services if further evaluation or intervention is needed.

The Feeding and Swallowing Program also offers a medical, nutritional, feeding and developmental assessment, called a multidisciplinary feeding evaluation. This evaluation helps in cases of limited oral intake, food refusal, picky eating, poor weight gain and difficulty transitioning from a feeding tube or supplemental feedings. A developmental pediatrician, dietitian, occupational therapist and speech-language pathologist perform the evaluation.

What can we expect from a multidisciplinary feeding evaluation?

A visit for an outpatient multidisciplinary feeding evaluation is approximately two hours long. A typical visit includes the following:

• Caregiver interview: Team members will ask about your child's medical history and your concerns regarding your child's feeding and/or swallowing.
• Observation: Team members will observe your child while eating and drinking to get a full sense of his or her challenges.
• Assessment: Team members will assess your child's current level of development and nutritional and medical status to determine what factors are contributing to their feeding concerns.
• Results: The evaluating therapist will share evaluation results with you and your child after the visit. A brief report will be handed to you before you leave, including recommendations for the safest diet for your child.
• Report: A more detailed report is sent in the mail within one to two weeks of the visit.
• Outpatient referral: Your child will be referred for any outpatient services if further evaluation or intervention needs to be addressed.

Individual feeding assessments are available for children with specific oral motor, oral sensory and developmental concerns that impact feeding. An occupational therapist or speech-language pathologist conduct the assessment.

What can we expect from an individual feeding assessment visit?

A visit for an individual feeding evaluation is approximately two hours long. A typical visit includes the following:

• Caregiver interview: The evaluating feeding specialist (an occupational therapist or speech-language pathologist) will ask about your child’s medical history, feeding history and caregiver concerns regarding your child's feeding and/or swallowing.
• Observation: The evaluating therapist will observe your child while eating and drinking to get a full sense of their challenges.
• Assessment: The evaluating therapist will assess your child's oral motor skills, oral/sensory skills, mealtime participation, behavior and development to determine which factors are contributing to their feeding concerns.
• Results: The evaluating therapist will share evaluation results with you and your child after the visit. A brief report will be handed to you before you leave, including recommendations for the safest diet for your child.
• Report: A more detailed report is sent in the mail within one to two weeks of the visit.
• Outpatient referral: Your child will be referred for any outpatient services if further evaluation or intervention needs to be addressed.

Individual feeding therapy is a once-weekly feeding session, where you and your child will meet individually with an occupational therapist or speech-language pathologist. This one-on-one therapy focuses on individualized feeding intervention for your child, as well as recommendations to help make progress with goals at home.

Intensive feeding therapy is a series of sessions held over two weeks with an occupational therapist and speech-language pathologist. They work together, one-on-one with your child, to help progress toward specific feeding goals. These sessions are for a child with swallowing or feeding challenges, as well as for family members or caregivers who feed the child most often.

Families will also meet with a clinical social worker and may meet with a dietitian depending on the child's needs.

Intensive feeding therapy is designed to lower stress and fear about eating, and it will help your child learn to take their next steps toward successful eating. Families will learn ways to work with a child's eating and to set goals that improve mealtimes.

Group feeding therapy is designed to support children with feeding difficulties and their families using consistent routines and strategies to reduce stress and anxiety regarding eating. Group feeding therapy promotes comfortable interactions with food and includes peer interaction, caregiver education and home program support.

Groups meet once per week for two-hour sessions. Groups are offered on a seasonal basis (usually summer, fall and spring). Children may return for more than one session if recommended by the therapy team.

Telemedicine feeding therapy is designed for patients with limited services within their communities or for families who would normally have to travel long distances. Our specialized occupational therapists and speech-language pathologists provide support to these children and families via video.