Diagnostic Testing

Diagnostic evaluations may be warranted to better assess swallowing and anatomy (Table 4). The modified barium swallow study (MBS) is the procedure of choice to assess oral, pharyngeal, and upper eso-phageal phases of swallowing. Seat positioning, food texture, and rate and amount of food presented can be manipulated during the performance of the MBS

Table 4 Diagnostic evaluation for patients with feeding disorders

Detailed history and physical examination Upper gastrointestinal contrast radiography

- Esophogram

- Small bowel follow-through Videofluoroscopic swallow study Gastric emptying study pH monitoring

Esophagogastroduodenoscopy with biopsies Antroduodenal manometry Fiberoptic endoscopic evaluation of swallowing CBC

Comprehensive metabolic panel Thyroid function

RAST analysis for food allergies Skin test for food allergies Plasma amino acids Urine organic acids Karyotype to determine the safest and most efficient method of feeding. Clinical evaluation prior to the MBS is essential so that appropriate food textures and liquid consistencies are available at the time of the study. Changes in head and neck position, such as chin tuck, should be tried before the actual study is performed to better correlate clinical and radiologic findings.

Additionally, a standard upper gastrointestinal contrast series utilizing barium is required for assessment of anatomy of the gastrointestinal tract. Children with repetitive vomiting or abdominal pain require endoscopic evaluation, and many will also need colonoscopy to rule out the possibility of underlying inflammatory bowel disease. Some children will need cranial imaging, such as computed tomography or magnetic resonance imaging, to search for evidence of intracranial mass lesions, hydrocephaly, or posterior fossa anomalies such as the Chiari malformation. Fiberoptic endoscopic evaluation of swallowing (FEES) allows for direct visualization of the hypopharynx and larynx during swallowing by use of a flexible laryngoscope. This will allow evaluation of the valleculae and pyriform sinuses as well as the assessment of anatomy during swallowing and potential aspiration problems. This procedure, however, does not provide information on the oral phase of swallowing. FEES may also be combined with sensory testing to induce a laryngeal adductor response. Lastly, increasingly important is the need for allergy evaluation, including consultation by an allergist. Appropriate skin testing may be necessary as well as appropriate RAST testing to search for response to food allergy.

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