Standardising videofluoroscopy assessment for bottle-fed babies
Reviewed by Roganie Govender

Swallowing problems in babies may occur for many reasons including complex medical problems, premature birth, and low birth-weight. Dysphagia causes several further morbidities such as poor nutrition and compromised respiration, often raising distress for both infants and their caregivers. Early detection and optimal management of dysphagia in infants may avoid future developmental problems and health issues. The authors of this paper describe a robust tool for the assessment and analysis of swallowing physiology in infants, namely BabyVFSSImP©. In this study, the authors used their experience of the adult Modified Barium Swallow Impairment Tool (MBSImP) as the basis for the development and validity testing of their new tool for babies. They performed 300 videofluoroscopy examinations on a cohort of bottle-fed babies ranging from one month to seven months in age, across two institutions. Twenty-one discrete physiological components of swallowing were identified: these grouped into five functional domains with the factor loading of each component achieving ≥0.5 during confirmatory factor analysis. The swallowing domains for the Baby VFSSImP© are: 1) lingual motion and pharyngeal swallow initiation; 2) palatal-pharyngeal approximation; 3) airway invasion-laryngeal closure; 4) aspiration; 5) pharyngeal transport and clearance. These domains were further explored for clinical relevance with external indicators of wellbeing such as feeding status, clinician recommendations and caregiver impact. Moderate associations were mostly found (defined as approximately 0.2). Strong positive correlation was found between the airway invasion-laryngeal closure domain (rs =0.66) and aspiration domain (rs = 0.88) with Rosenbek’s Penetration-Aspiration Scale (PASmax). The authors have highlighted that this tool is the first of its kind to promote standardised videofluoroscopic assessment of swallowing physiology for babies. Using this tool, clinicians may have greater confidence, not only in identifying aspiration, but also in determining its physiological source to better target their swallowing/ feeding interventions and recommendations.

BaByVFSSImP© A Novel Measurement Tool for Videofluoroscopic Assessment of Swallowing Impairment in Bottle-Fed Babies: Establishing a Standard.
Martin-Harris B, Carson KA, Pinto JM, Lefton-Greif MA.
DYSPHAGIA
2019.