A fiberoptic endoscopic evaluation of swallowing (FEES) is a test used to see if a child has dysphagia. When a person has dysphagia, he or she has trouble swallowing. It can lead to serious problems, such as trouble with feeding and breathing, or respiratory infections such as bronchiolitis or pneumonia. During the FEES, a thin, flexible tool called an endoscope is put into the nose and down the back of the throat. Parts of the throat are viewed as the child swallows. The test is done by an Ear, Nose and Throat doctor (ENT) and a Speech-Language Pathologist (SLP).
Dysphagia and aspiration
When your child swallows food, it passes from the mouth down into the throat (pharynx). From there, the food moves down through a long tube (esophagus) and into the stomach. This is made possible by a series of actions from the muscles in these areas. If the muscles are not working properly, your child may have trouble swallowing. This may result in aspiration. Aspiration is when something enters the airway or lungs by accident. It may be food, liquid, or some other material. This can cause serious health problems, such as pneumonia. Aspiration can happen when a person has dysphagia.
Why a FEES is done
A FEES can help find out if your child is having problems with any part of the swallowing process. An SLP will often first see how well your child is feeding and swallowing with other simple tests such as a clinical or bedside swallowing evaluation. A FEES is then done to get more information about your child’s swallowing. If your child has any dysphagia, aspiration is always a risk.
A FEES may be appropriate for the following reasons:
- Coughing or choking with eating or drinking
- Food sticking in the throat
- Difficulty or pain while swallowing
- Your child is breastfed with concerns for swallowing difficulties
- Unexplained respiratory symptoms that may be from aspiration
- It is recommended by your child’s doctor or swallowing therapist.
How to prepare for the test
- Explain to your child what will happen.
- Use words he or she can understand.
- Bring your child’s bottle, spoon or cup.
- Bring any liquids your child drinks.
- If your child is a picky eater, or has food allergies, bring food that he or she will or can eat.
- If your child has problems with certain foods or textures, please bring those foods to the study.
- You may give medicine to your child at any time before the test.
- Please do not give your child food, drinks or chewing gum less than 2 hours before the test.
How a FEES is done
If your child is in the hospital, the FEES will be done in his or her hospital room. If the child is being seen as an outpatient, this will be done in a healthcare provider's office or clinic.
You can expect the following:
- During the test, your child will be seated and awake.
- The ENT doctor will put the endoscope through the nose and down into the throat (pharynx) (Picture 1). Your child may feel mild discomfort with the scope in place.
- The endoscope allows your ENT and SLP to see parts of the voice box (larynx), throat (pharynx), and breathing tube (trachea) on a video screen.
- The ENT and SLP look at the video screen to see your child swallow. They can see if he or she is aspirating. Your ENT and SLP will look at how well saliva is swallowed. They will look at how well breathing and swallowing happen together and how well the airway seals itself when your child swallows.
- They will also be able to see if there are any problems with the shape (anatomy) of your child’s throat.
- Your child may swallow small amounts of food or liquid during the test. These may be dyed so they can be seen on the screen.
- At the end of the FEES, the endoscope will be removed from the throat
- If your child is breastfed, the endoscope will be passed first to allow us to view the child’s anatomy and ability to swallow secretions prior to beginning. Once that is completed, the ENT and SLP will ask you to breastfeed your child to allow them to assess your child’s ability to swallow.
After the test
- The ENT and SLP will give results and make recommendations immediately.
- If necessary, we will teach you about the foods and liquids that are recommended for your child.
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