Use of the videofluoroscopy swallow study (VFSS), also known as the modified barium swallow (MBS), continues to increase in children. This article reviews the scope and limitations of the examination, explores the current techniques and illustrates some of the main findings. As moving images are key to the understanding of the use of this technique short videos are available in the on-line version of this paper.

A prospective controlled study with repeated measures before and after surgery examined the medical, surgical, and health outcomes of gastrostomy for children with disabilities at a tertiary paediatric referral centre in the North Thames area, UK. Anthropometric measures included weight, mid-upperarm and head circumference. Five-day prospective food diaries were completed and data on physical health and surgical outcomes recorded. Seventy-six children participated and underwent gastrostomy (44 males, 32 females; median age 3y 4mo, range 4mo-17y 5mo), and 35/76 required an anti-reflux procedure. Categories of disability were: cerebral palsy (32/76), syndrome of chromosomal or other genetic origin (25/76), slowly progressive degenerative disease (11/76), and unconfirmed diagnosis (8/76). Most children had gross motor difficulties (99%) and were non-ambulant (83%). Oromotor problems were identified in 78% of children, 69% aspirated, and 65% were fed nasogastrically before surgery. The mean weight before surgery was -2.84 standard deviation score (SDS; SD 2.21, range -9.8 to 3.4). Two-thirds of children achieved catchup growth postoperatively: weight-for-age (mean difference 0.51 SDS, 95% CI 0.23-0.79, p=0.001) and mid-upper arm circumference (mean difference 1.12cm, 95% confidence interval 0.50-1.75, p=0.001). Health gains included a reduction in drooling, secretions, vomiting, and constipation. Major surgical complications were found in 13/74 children. The study provides evidence that catch-up growth and health gains are possible following gastrostomy.

This paper describes the communication development in 11 children with Angelman's syndrome. We have investigated the clinical observation that these children appear to have a greater ability with receptive rather than expressive language and assessed these skills using published communication schedules; the Bzoch‐League (REEL) Scale and the Pre‐verbal Communication Schedule. In addition, we looked at the understanding and use of non‐verbal communication, such as natural gesture. The data collected did not, in fact, show a significant gap between receptive and expressive skills, except in the older children, but it did highlight the fact that these children develop very few words and have difficulty in using gestural or sign systems. It also emphasised the different patterns of ability in familial and non‐familial cases, although the small numbers in this study made it inappropriate to conclude anything significant from the data. The results of the study will be presented and the implications for the children's remedial programmes will be discussed, particularly in the use of Makaton signing and other methods of augmentative communication.

The communication development in 11 children with Angelman's syndrome is described. The clinical observation that these children appear to have a greater ability with receptive rather than expressive language is investigated and these skills assessed using published communication schedules. In addition the understanding and the use of nonverbal communication such as natural gesture was studied. The data collected highlight the fact that these children have developed very few words and have difficulty in using gestural or sign systems. This has implications for speech and language therapists and the children's remedial programmes. Possible future longitudinal studies are suggested.

No participant had dysphagia pre-surgically. Seventy three percent (8/11) had dysphagia at 1-2 weeks post-surgery, primarily characterized by impaired lip closure (8/8), poor mastication (8/8), and inefficient oral transit (8/8). Whilst dysphagia severity was largely mild (6/8) in presentation, data suggest that assessment and monitoring of this disorder may be required in the acute phase post-surgery. Overall however, prognosis appeared positive, with 75% (6/8) of participants managing a full oral diet at 2 months post-surgery.