Fiberoptic Endoscopic Evaluation of Swallowing in the Breastfeeding Infant

Abstract

ObjectiveTo demonstrate the importance of utilizing fiberoptic endoscopic evaluation of swallowing (FEES) when evaluating breastfeeding infants with suspected dysphagia. Failure to recognize and account for the fundamentally different physiology of the primarily breastfed infant can lead to false assumptions about the safety of breastfeeding in this understudied patient population.MethodsCase‐series. The medical records of patients referred to an urban, university‐based, pediatric hospital for FEES from February 2017 to October 2020 were reviewed. Their presenting symptoms, dysphagia severity, comorbidity, dysphagia workup, and management were analyzed. The standardized Dysphagia Outcome and Severity Scale was used to appraise dysphagia severity.Results204 FEES exams were reviewed. 35 were conducted on breastfed infants. 34 of the 35 infants calmed for the FEES exam while breastfeeding. Cohorts were defined by a particular presenting sign (cough, laryngeal congestion, choking, and respiratory illness) and anatomical characteristic (laryngomalacia, vocal cord paralysis, aspiration, penetration, etc.) and then compared to all other exams. The average dysphagia score for all the exams was 2.37. Patients presenting with laryngeal congestion had an average dysphagia score of 2.81. There was no difference in dysphagia score based on comorbidities or anatomy.ConclusionsFEES is the instrumental exam of choice when evaluating a primarily breastfed infant who has suspected dysphagia. The exam is well tolerated and provides accurate, objective information while accounting for this population's unique swallowing physiology. Primarily breastfed infants presenting with laryngeal congestion are more likely to have clinically worse dysphagia than those presenting with other clinical symptoms.Level of Evidence4 Laryngoscope, 133:2803–2807, 2023

Current opinion in otolaryngology and head and neck surgery: the role of the otolaryngologist in the management of pediatric dysphagia

“…A recent case series of 204 FEES examinations, published by Schroeder et al , demonstrated that FEES was the examination of choice for a breastfeeding infant with suspected dysphagia. This study shows that FEES is well tolerated and preferred in breastfeeding infants [20 ▪▪ ]. Both an MBS and FEES provide important complementary diagnostic information, as the MBS can confirm whether or not aspiration is present, and a FEES can help assess from where the airway invasion is occurring.…”

Breastfeeding in infants who aspirate may increase risk of pulmonary inflammation

“…Breastfeeding FEES can be used to specifically evaluate breastfeeding safety and studies have found that adjustments in positioning can improve swallow function in breastfeeding infants 12,13 . Unfortunately, this test is not readily available at all institutions, requires specialized expertise and patient cooperation, and has its own limitations related to visualization of aspiration as it is happening 14–16 . Because of these limitations, many providers rely on VFSS to assess swallow function in breastfed infants.…”