Variability in Swallowing Biomechanics in Infants with Feeding Difficulties: A Videofluoroscopic Analysis

Clinicians performing feeding evaluations in infants often report swallow variability or inconsistency as concerning. However, little is known about whether this represents pathological incoordination or normal physiologic variance in a developing child. Our retrospective study explored quantitative...

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Bibliographic Details
Published in:Dysphagia 2022-12, Vol.37 (6), p.1740-1747
Main Authors: Fuller, Laura, Miles, Anna, Dharmarathna, Isuru, Allen, Jacqui
Format: Article
Language:English
Subjects:
Babies
Biomechanics
Dysphagia
Feeding
Gastroenterology
Hepatology
Imaging
Infants
Medicine
Medicine & Public Health
Original
Original Article
Otorhinolaryngology
Pediatrics
Pharynx
Radiation measurement
Radiology
Risk factors
Swallowing
Variability
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Summary:Clinicians performing feeding evaluations in infants often report swallow variability or inconsistency as concerning. However, little is known about whether this represents pathological incoordination or normal physiologic variance in a developing child. Our retrospective study explored quantitative videofluoroscopic measures in 50 bottle-fed infants (0–9 months) referred with feeding concerns. Our research questions were as follows: Is it possible to assess swallow to swallow variability in an infant with feeding concerns, is there variability in pharyngeal timing and displacement in infants referred for videofluoroscopy, and is variability associated with aspiration risk? Measures were taken from a mid-feed, 20-s loop recorded at 30 frames per second. Each swallow within the 20-s loop ( n  = 349 swallows) was analysed using quantitative digital measures of timing, displacement and coordination (Swallowtail™). Two blinded raters measured all swallows with strong inter-rater reliability (ICC .78). Swallow frequency, suck-swallow ratio, residue and aspiration were also rated. Variability in timing and displacement was identified across all infants but did not correlate with aspiration ( p  > .05). Sixteen infants (32%) aspirated. Across the cohort, swallow frequency varied from 1 to 15 within the 20-s loops; suck-swallow ratios varied from 1:1 to 6:1. Within-infant variability in suck-swallow ratios was associated with higher penetration-aspiration scores ( p  
ISSN:0179-051X
1432-0460
DOI:10.1007/s00455-022-10436-2