Swallow Study

Mar 28 2013 Leave a Comment

feedingOne of the common tests that doctors will run for children who aren’t feeding well is a swallow study. A swallow study will show if fluid is going into the lungs (aspirating) while feeding and if the swallow mechanism is working correctly.

A swallow study is a relatively simple procedure, but can be very helpful if you suspect that your child might be aspirating when feeding. Aspiration is very dangerous and can lead to a variety of health issues.

A speech-language pathologist performs the swallow study. For infants that are breast or bottle feeding, barium is added to bottles of formula in a variety of thicknesses. Usually they have one without thickener and one or two thickened bottles. Will sat in a seat similar to a car seat and I fed him the bottles as the technician operated the videofluoroscope which is similar to an x-ray. This machine is able to record video instead of just one image like a standard x-ray. This allows the specialist to view what is going on inside the baby’s mouth and throat as they swallow.

As the baby swallows the different bottles with a variety of thin or thickened liquid, the specialist can watch the path it takes from the mouth down the esophagus and into the upper stomach. They will see if the child is able to successfully block their airway or if they allow any of the fluid to leak through. If the child is allowing thin fluid into their airway and ultimately their lungs, the doctors will test to see if the child is more successful with thickened formula. In severe cases where children aspirate all fluid alternative feeding methods will need to be used.

When Will was a baby he had a small swallow issue, which affected his bottle feeding. He was letting fluid into his windpipe, but luckily his vocal cords were clamping down and pushing the liquid back out. Thickening his formula allowed his swallow mechanism to work correctly and keep the liquid out of his windpipe. Jack also had a swallow study done, but he didn’t show any signs of aspiration.

Thickening formula can be achieved very simply with a few methods.

· Rice cereal – We found that it clogged the bottle nipples and led to more issues.

· Powder thickeners – We found that these didn’t clog the bottle nipples like the cereal. However they would continue to thicken the formula throughout the feeding, which can prove problematic.

· Gel thickeners – We had the most success with gel thickeners. They didn’t continue to thicken over time, so we could maintain the correct consistency.

Once we started thickening Will’s formula he went back to eating normally. The swallow study was one of the easiest procedures required of us with little to be concerned about.

 

Resources:

http://www.asha.org/public/speech/swallowing/Videofluoroscopic-Swallowing-Study/

http://www.refluxrebels.com/Acid_reflux/Acid_reflux_formula_thickening.html

Filed Under: GI Tagged With: ,

Swallow Study

Sep 09 2009 Leave a Comment

Yesterday was William’s swallow study. This was the last of the tests GI suggested we do with him. During the swallow study he sat in a seat that looked similar to a car seat next to a fluoroscope (like the one used during the upper GI). We fed him bottles of barium and then watched how he swallowed the liquid. For him we tried thin (normal formula consistency) and thickened (slightly thicker than we use) liquid. They were looking to make sure that he doesn’t aspirate (let the liquid go into his lungs) when he swallows. We switched back and forth with the two thicknesses during the test.

We found that he was almost aspirating the thin liquid (normal formula consistency). He was letting it go into his windpipe and only his vocal cords were closing down and pushing it out. Not good. With the thickened liquid he did much better. He was able to control is swallow and move it down his esophagus smoothly, not letting it in his wind pipe. He needs to be on the thickened formula for at least the next several months; then we will retest him and see if he has gotten better.

Even though this isn’t the original reason that we put him on the thickened formula (reflux was), it is good that he is on it and likes it. It also explains why I have noticed that he eats smoother and faster. It is easier for him to control and move through his swallow mechanism. I am not sure what it means for him learning to eat solids. That is a question for our feeding specialist, Robin Glass.

The most interesting thing to me was that this was the test that I thought the least about and figured wasn’t going to show much. I even thought about canceling it. (I also thought that about his eye appointment.) I guess I need to stop thinking that.

Filed Under: GI, William Tagged With: , ,

Doctors, procedures and appointments, Oh My!

Aug 12 2009 Leave a Comment

It has been a busy day so far. This morning we had our appointment with GI at Children’s Hospital and I would say it was productive. While he didn’t provide answers to all of our questions he did agree that scheduling some procedures to rule things out was a good idea. So here is William’s schedule for the next few weeks.

8/14 – Appointment with a 2nd GI doctor for a 2nd opinion (with the consent of our GI doc).

8/17 – Endoscopy at Children’s Hospital – yes he has to be put to sleep for this one, but we don’t have to stay overnight. They will stick a camera down his throat and see what they can in his esophagus, stomach and upper small intestines. They will take biopsies of tissue in all locations to make sure there isn’t anything going on.

8/18 – am – Upper GI study – William will have to drink the Barium bottle and then they watch the flow of the liquid down his esophagus and into his stomach and small intestines.
pm – 1st appointment with the Occupational Therapy (OTPT) feeding specialist at Children’s Hospital.

8/20 – Appointment with an eye doctor to make sure his eye movements are normal.

9/3 – Follow-up appointment with 1st GI doctor.

9/8 – Swallow study – to make sure Will is not aspirating his food as he eats.

Oh yah and Jack has a dentist appointment on Friday too.

All of this stuff may end up being overkill, but we just want to be thorough in ruling things out or finding something. With Jack we felt like we fiddled around and waited to long to do some of these things and it may have made a difference in his outcome. If Will ends up with a feeding tube after everything we just want to make sure that we tried all we could and in a timely fashion to try to head it off.

To give you an idea when we did stuff with Jack he had an Upper GI at 2.5 weeks old (that is how we discovered his reflux, because both boys are pretty much silent refluxers – meaning they don’t spit up a ton), a Swallow Study at 4 months old (3 months into feeding issues) and an Endoscopy at 6 months (he already had a feeding tube by this point).

All of these results may prove to be normal, but at least we will have ruled out that there is anything going on in his stomach and throat. Jack will get lots of use out of the new portable DVD player we got. I wonder what the favorite movie will be.

Filed Under: GI, William Tagged With: , , , , , ,