Pediatric fiberoptic endoscopic evaluation of swallowing

Pediatric dysphagia is the presenting feature of many underlying diagnoses. Between July 1993 and July 1999, 643 fiberoptic endoscopic evaluations of swallowing (FEES) were performed on 568 patients. The median age of the pop ulation was 2.5 years (range, 3 days to 21 years). The principal medical an d surgical diagnoses of the patients at the time of presentation to the FEE S clinic were prospectively recorded: 36% of the patients presented with a diagnosis of structural abnormalities of the upper aerodigestive tract or a irway; 26% with neurologic diagnoses; 12% with gastroenterological disorder s; 8% with genetic syndromes; 7% with pulmonary dysfunction; 5% with premat urity; 3% with cardiovascular anomalies; and 2% with metabolic problems. Th e patients were classified according to the following feeding regimens: 9% normally fed; 38% orally fed with limitations; 13% orally fed, but with req uired supplemental tube feedings; and 40% prohibited from taking nutrition orally. The FEES enabled the following classification of feeding abnormalit ies: 15% had normal feeding; 56% exhibited behavioral abnormalities, includ ing sensory-based feeding disorders; 15% exhibited structural abnormalities ; 16% exhibited neurologic abnormalities; 1.5% exhibited metabolic abnormal ities; and 0.5% exhibited cardiorespiratory abnormalities. The unique aspec ts of pediatric dysphagia are highlighted, and the role of FEES in the work up of this challenging aspect of pediatric otolaryngology is discussed.