Fiberoptic Endoscopic Evaluation of Swallowing (FEES) Clinic

What is a fiberoptic endoscopic evaluation of swallowing?

A fiberoptic endoscopic evaluation of swallowing is a clinic visit to evaluate your child’s feeding and swallowing function. Our care team evaluates your child through caregiver interviews, observation of your child while eating, and direct visualization of their swallowing structures using a child-sized endoscope. The endoscope is a thin, flexible tube that is attached to a bright light and a camera.

During the procedure, a team member passes a thin tube through the passages in your child’s nose. It allows the care team to view the structures of your child’s upper aerodigestive tract (inside of the nose and throat) and how they function during swallowing and at rest.

Our evaluation helps identify risk factors for aspiration (passing of liquid and/or food into the lungs) and identify adaptations that can help make eating and drinking safe for your child. Examples of adaptations include changing your child’s position, type of bottle or cup, or consistency of food and drink. The goal of the evaluation is to decrease health risks that may occur from aspiration (such as lung problems).

Who needs a swallowing evaluation?

Children who are referred to the FEES Clinic typically have a diagnosis of or suspicion for dysphagia, or difficulty swallowing. These children may have difficulties with aspiration.

What is the FEES Clinic?

The FEES Clinic is a collaborative effort between the Pediatric Otolaryngology Department and the Swallowing Disorders Clinic at Children’s Hospital Colorado. In the FEES Clinic, a multidisciplinary team that includes otolaryngology (ear, nose and throat), speech pathology, occupational therapy and nursing personnel evaluate a child’s feeding and swallowing skills.

The FEES may be an alternative or additional evaluation to more traditional methods of swallowing evaluation, such as the upright modified barium swallow. A modified barium swallow study uses X-rays to make a video of your child eating and drinking various foods and liquids. This allows providers to examine the anatomy in your child's mouth and throat as well as their swallowing technique.

FEES does not involve radiation, and it can be done in any exam room in virtually any patient position. Most patients tolerate the FEES well. Children of any age may be referred to the FEES Clinic. Team members will review your child’s records to determine if this is the most appropriate evaluation for your child. The FEES Clinic scheduler will assist your family in scheduling and preparing for the visit.

What can we expect from a FEES clinic visit?

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

• Caregiver interview: Team members will ask about your child’s medical history and caregiver concerns regarding your child’s feeding and swallowing.
• Observation: Team members will observe your child while eating and drinking.
• A brief endoscopy procedure: Our team makes a significant effort to ensure that this part of the evaluation is as comfortable as possible for your child.
  • The doctor will numb the inside of your child’s nose with a spray anesthetic (pain medication) and place 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.
  • Your child (if able) and caregiver can observe the procedure as it is happening on a screen.
  • The procedure lasts anywhere from less than a minute to approximately five minutes.
  • Most children do cry. This is normal and expected. If you feel that your child will not tolerate this procedure well, please contact our scheduler in advance. We can connect you and your child to child life specialist who can provide suggestions for making this procedure easier.
• Results of the FEES evaluation: The doctor will share the FEES evaluation results with you and your child (if developmentally appropriate) after the visit. A brief report is handed to you before you leave, including recommendations for the safest diet for your child.
• Report: A longer 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 to address growth or nutrition.

Why choose Children’s Colorado?

The FEES Clinic combines pediatric expertise in otolaryngology, speech pathology and occupational therapy to provide the most child and family-centered evaluation of swallowing available. Our experience with children and our pediatric-sized equipment uniquely qualify us to provide this service.