August 2023 Pediatrics Newsletter

“When educating the minds of our youth, we must not forget to educate their hearts.” — Dalai Lama

Hi all! For anyone new to the newsletter, my name is Ashley Stone, and I am the pediatric SLP at DiagnosTEX. Our outpatient Modified Barium Swallow Study clinic is now open for pediatric patients of all ages! We have supported seating devices for those that are in need and have the capability to also complete studies in a side-lying position. We accept most insurances.

Guest Expert: I’d like to welcome Landon Hughes MS, CCC-SLP, from Therapedia, LLC in Keller. He prepared the following for us all this month. Enjoy!

Hi, my name is Landon Hughes and I am a Speech-Language Pathologist and the Speech Therapy Clinical Coordinator at Therapedia, LLC in Keller, TX. I would like to thank Ashley Stone, MS, CCC-SLP for allowing me to be a contributor to the DiagnosTEX Pediatric Newsletter. I found a topic that caught my attention and I thought it would lead to some meaningful discussions among fellow SLP’s in the community.

In 2018, Reza Rahbar and the multidisciplinary team with the Center for Airway Disorders (CAD) at Boston Children’s Hospital proposed a Systematic Weaning Protocol (SWP) as a controlled method to gradually reduce the thickness of liquids offered to children with a known history of aspiration.


  • 50 children with documented aspiration (clinically diagnosed, airway assessment, VFSS). Patients with a history of silent aspiration were included.
  • All participants were initially receiving thickened liquids.
  • A 10% reduction in thickness was made every 2 weeks based on clinical symptoms.
  • Caregivers progressed to the next incremental level if there were no signs or symptoms of aspiration.


  • 44 (88%) out of 50 children in the study were able to reduce the amount of thickener used in liquids.
  • 39 (78%) of patients were able to wean to tolerate a thin-fluid diet.
  • Temporary stalls were observed in 14 of the patients that eventually progressed to a thin-fluid diet. Stalls were the result of cough or concern noted on VFSS, and parental concern.
  • 95% of patients that weaned to a thin-fluid diet did not experience a significant respiratory event during the SWP.
  • 2 patients developed pneumonia.
  • 44% of successfully weaned patients were evaluated by a follow up VFSS secondary to parental concern. None of these cases demonstrated silent aspiration.

This study brings to light an important aspect of outpatient feeding therapy. How to balance progression and safety. There are aspects of feeding that fluctuate greatly and that are largely out of our control. These include: positioning, flow rates, consistencies of foods and liquids, pacing, and who is feeding the child. When working with children with a history of aspiration, thickening liquids is a common recommendation that allows for improved swallow safety and may also allow children to increase the volume of liquids accepted safely for improved nutrition and hydration. We can all agree that thickened liquids are not a permanent solution. However, would it be useful to have a systematic method of weaning patients from thickened liquids while conducting follow up VFSS to guide our recommendations? This article was definitely thought provoking and illustrates the difficulty in standardizing a strategy in feeding therapy.

Reference: Wolter NE, Hernandez K, Irace AL, Davidson K, Perez JA, Larson K, Rahbar R. A Systematic Process for Weaning Children with Aspiration from Thickened Fluids. JAMA Otolaryngol Head Neck Surg. 2018 Jan 1;144(1):51-56

Thank you to Therapy 2000, Angels of Care, and Cook Children’s Home Health for inviting me to educate your therapists on the importance of Modified Barium Swallow Studies!

Do you have an interesting topic that you would like to share in this newsletter, whether it be a research article you have read or a patient you have treated? Email me if you are interested!

We are always available Monday-Friday, 8:00am-4:30pm, to answer any questions you may have! If you have any questions regarding the referral process or patient specific questions, please email me directly at

I, and the rest of the DiagnosTEX staff, look forward to helping you serve your patients and ensure a safe diet for ALL children.

Keep an eye out for a newsletter each month & feel free to share with your colleagues and friends!