VIDEOFLUOROSCOPIC SWALLOW STUDY (VFSS) OUTCOMES AND CLINICAL RECOMMENDATIONS IN PEDIATRIC DYSPHAGIA: RETROSPECTIVE ANALYSIS

Introduction Videofluoroscopy (VFSS) is considered the gold standard for the assessment of swallowing in the pediatric population. It allows comprehensive evaluation of the oral, pharyngeal, and esophageal phases of swallowing, as well as the effectiveness of airway protective mechanisms. Additionally, it allows clinicians to provide specific recommendations and targeted interventions aimed at improving feeding management and reducing the risk of aspiration. This study aims to describe the VFSS outcomes and analyze the recommendations given in real-world clinical practice, investigating the association between signs of dysphagia detected on VFSS and functional feeding outcomes. Materials and methods We retrospectively reviewed 124 consecutive VFSS reports from Great Ormond Street Hospital, dated May to August 2024. Letters collected complete information according to the VFSS protocol and allowed video evaluation by the researchers were included. Data collected included patient age at VFSS, sex, diagnosis, Penetration-Aspiration Scale (PAS) and Bolus Residue Scale (BRS) scores, CEDAS (Children’s Eating and Drinking Ability Classification System) levels, and recommendations provided. Descriptive statistics summarized frequencies, while the Kruskal-Wallis test assessed associations between mean PAS and BRS scores and CEDAS levels. Results The final sample included 85 patients (mean age 4.59 years, SD 4.06; 34.1% female) with a variety of diagnoses: 31.8% had genetic disorders, 16.5% presented with upper aerodigestive tract congenital anomalies, 9.4% had recurrent cough or chest infections, 8.2% had cardiorespiratory diseases, 8.2% had neurodevelopmental disorders, 7.1% had neuromuscular diseases, 5.9% had cerebral palsy, 3.5% had other conditions, and 2.4% had tumors. No statistically significant differences were observed in mean PAS scores across CEDAS levels (H(5) = 3.30, p = 0.653). Mean BRS scores showed a trend toward significance across CEDAS levels but did not reach the threshold (H(5) = 10.28, p = 0.068). Diet modification was recommended for 37.6% of patients. Specifically, 16.5% were advised to add a thickener to liquids, 11.8% to reduce thickener amount, 9.4% to modify solid food consistency, 1.2% to transition to tube feeding, and 1.2% to move from a modified diet to an age-appropriate diet. Recommendations beyond dietary changes included decreasing the number or volume of bites (29.4%), modifying feeding position (4.7%), reducing feeding speed (4.7%), promoting self-feeding and exploration of new tastes (4.7%), implementing a free water protocol (2.4%), using an empty spoon to encourage clearing swallows (2.4%), and offering food and liquids only when the child was alert and stable (2.4%). In 31 patients the VFSS did not lead to any changes in diet or feeding management. Discussion and conclusion VFSS effectively guided feeding and functional recommendations in pediatric patients with dysphagia. No significant correlation was found between the severity of dysphagia signs and CEDAS levels. VFSS remains essential for individualized management to ensure safe feeding in children. It is desirable that future research focus on the relationship between instrumental assessments and functional outcomes to optimise the treatment of paediatric dysphagia.