Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
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Monroe Carell Jr.
Children's Hospital
at Vanderbilt
2200 Children's Way
Nashville, TN 37232

(615) 936-1000

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Frequently Asked Questions


What is Aspiration? 
Aspiration occurs whenever secretions, solid food or liquids "go down the wrong tube" and enter the airway and lungs. Aspirating material into the lungs can lead to respiratory problems, such as pneumonia. While there may be observable signs that accompany aspiration events, such as coughing, choking or eye-reddening during eating, or a gurgly vocal quality after swallowing, infants and children can also aspirate "silently," or with no observable symptoms.

What are Some of the Signs and Risks for Aspiration?

  • Any child with a history of recurrent pneumonia or chronic respiratory illness
  • Any child with neuromuscular disorders, both structural and functional (e.g., cerebral palsy, etc.)
  • Children with excessive drooling, especially if seen to cough or gag on own secretions
  • Infants/children with a history of gastroesophageal reflux disease
  • Children who have acquired brain damage secondary to open or closed head injuries, with particular importance on those with brainstem/cranial nerve involvement
  • Infants who are born prematurely
  • Infants/children with chronic heart disease
  • Infants/children with craniofacial anomalies (e.g., cleft palate, etc.)
  • Infants/children with congenital syndromes
  • Children with upper airway anomalies (e.g., choanal atresia and stenosis; achalasia; congenital defects of the larynx, trachea, and esophagus; tracheoesophageal fistulas, etc.)
  • Children who exhibit failure to gain weight or poor weight gain; diagnosis of failure to thrive
  • Children exhibiting lethargy or decreased arousal during feedings
  • Sucking and swallowing incoordination or weak suck
  • Breathing disruption or apnea during feeding
  • Children with behavioral feeding problems (e.g., refusal to eat new food textures or unexplained food refusal; rigid feeding behaviors; irritability during or soon after feeding)
  • Children with feeding periods longer that 30-40 minutes
  • Children receiving enteral/tube-feedings, especially under age 2
  • Children who exhibit aversive responses to oral stimulation

What is a Videofluoroscopic Swallow Study?
A Videofluoroscopic Swallow Study (VFSS) is known by several other names, such as a Modified Barium Swallow Study, or Oral-Pharyngeal Motility Study. The VFSS is a diagnostic procedure done under a moving X-ray (fluoroscopy) that is used to further the clinical understanding of the swallowing process and assess the swallowing mechanism. It analyzes the oral and pharyngeal structures and motility in relation to each other during eating, breathing and swallowing. Events before, during and after the swallow can be viewed during a VFSS, helping the clinician to determine which food textures under which circumstances a child may eat or drink safely

When is a Videofluoroscopic Swallow Study Appropriate?

It may be appropriate for your child to have a Videofluoroscopic Swallow Study if your child:

  • Coughs or chokes during feeding
  • Takes longer than 30 minutes to drink a bottle
  • Has difficulty consuming the volume or type of food recommended for his/her age
  • Has a history of poor weight gain, or is diagnosed Failure To Thrive
  • Has a history of unexplained respiratory congestion or illness
  • Is tube-fed, has a history of swallowing problems, and you are considering re-introducing food by mouth
  • Gags excessively with feeding
  • Forgets to breathe, experiences skin-color changes or sweats during feeding
  • Describes a sensation of something in his/her throat
  • Experiences difficulty swallowing large bites or certain textures

When is a Feeding Evaluation Appropriate?
It may be appropriate for your child to receive an outpatient feeding evaluation if your child:

  • Is experiencing difficulty transitioning to an age-appropriate diet
  • Has difficulty chewing food adequately
  • Is a noisy bottle-feeder
  • Takes longer than 30-minutes to take a bottle
  • Has a very limited diet
  • Has difficulty gaining weight, or is diagnosed Failure to Thrive
  • Refuses to eat certain food textures
  • Is medically ready for weaning from tube-feeds

Last Edited: December 22, 2014
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