December 2023 Pediatrics Newsletter

“Love, Peace, and Joy came down on Earth on Christmas Day to make you happy and cheerful. May Christmas spread cheer in your lives!”

Hi all!

For those that are new to the newsletter, my name is Ashley Stone. I am the Pediatric Program Manager and a Speech Language Pathologist at DiagnosTEX. Our outpatient Modified Barium Swallow Study clinic is now open for pediatric patients of all ages! We have supported seating devices and have the capability to also complete studies in a side-lying position. We accept most insurances. Contact me for more information on how to make a referral.


We are so excited to celebrate a successful 20 years of serving the metroplex! The company began on December 3, 2003, with Pam Ragland and Ronda Polansky leading the way in conducting mobile Modified Barium Swallow Studies for the adult population. I am forever grateful to them for bringing me on last year to expand our services to the pediatric population and lead the way for a more personalized experience to what can be a life altering diagnostic assessment. We are looking forward to many more years of continual growth!


Send us your Cook Children’s STAR Medicaid patients! 😃 We are eager to serve more children in our community!

Need December CE’s before the end of the year?

Deciphering Dysphagia with Ampcare’s ESP™ (Effective Swallowing Protocol) On-Demand + Zoom Webinar

Tuesday & Wednesday, December 5-6, 2023 4-6 pm CT (5-7 pm ET) *8 Hours Advanced ASHA CE. To register online go to:

“Impact of Cardiac Surgery on Oral Feeding in Children with Congential Heart Defects”

by Hema Desai (M.S. CCC-SLP, BCS-S, CLEC, NTMTC) and Joanne Starr, Cardiologist (MD, FACS).

I have always said I believe almost every “heart baby” needs a swallow study. I have based that not only on the numerous studies I’ve conducted where dysphagia is present, but also on just the simple fact that the if the heart is having difficulties regulating the body at rest, imagine the challenges it faces to coordinate a Suck:Swallow:Breathe pattern hundreds of times per day. I recently listened to a course conducted between these ladies that frequently collaborate on patients. There was not enough time for the presenters to cover every cardiac defect, so this is not a comprehensive list.

  • Approximately 40,000 infants are born with CHD each year, which is the most common birth defect in the U.S.
  • The prevalence of feeding/swallowing disorders in infants with CHD is > 50%.
  • Vocal Fold Injury can occur as a result of Recurrent Laryngeal Nerve (RLN) damage during surgery. You may recall there are 2 RLNs, with the left one being longer than the right, leaving of patients presented with pharyngeal dysphagia following surgery & another 33% presented with silent aspiration.
  • Cardiac lesions resulting in increased pulmonary blood flow (VSD, ASD, PDA) can cause feeding challenges pre and post operatively. Pre-operatively, patients present with increased metabolic demand, tachypnea, and increased work of breathing, at rest. Once again, if their heart rate & respiratory rate are elevated at rest, we can only suspect they will rise with bottle/breast feedings. Post-operatively, aberrant motor patterns are present for their SSB coordination due to learning to feed in a chronic tachypneic state.
  • Cardiac lesions resulting in decreased pulmonary blood flow (Pulmonary stenosis/atresia; Tetralogy of Fallot; Ductal dependence) can cause feeding challenges pre and post operatively. These patients have decreased feeding opportunities at birth until improved pulmonary blood flow is established. Their feeding progression and opportunities are dependent on the timing of intervention – Some patients will PO, while they are monitored for TET spells (hypercyanosis with agitation, fever or illness).
  • Hypoplastic Left Heart Syndrome presents in 3 stages of treatment, so it is important to know which stage your patient is in when treating them for dysphagia.
    • Stage 1 – The Norwood Procedure is completed at 0-2 weeks of life. A BT Shunt is placed to control pulmonary blood flow. Children can outgrow the shunt, which results in lower oxygen saturations.
    • Risks:
  • Growth failure
  • Impaired oral motor skills
  • High risk for vocal fold injury & aspiration due to nerve injury
  • 25-75% of patients require tube feedings at time of discharge
  • Delayed oral feeding initiation
  • Fluid restrictions
  • Hypoperfusion to the gut (Increased risk for NEC; gut intolerance)
  • Limited bonding experience due to early surgical intervention
    • Stage 2 – Bi-directional Glenn procedure between 4-6 months of age. The goal is to decrease volume load on the ventricles & keep oxygen sats between 80%-90%. Up to 22% of patients fail to achieve adequate caloric intake, requiring supplemental tube feeds. Their feeding method at the time of admission is unlikely to be changed after stage 2 intervention. Remember, at this age, critical developmental milestones are supposed to be met, which can negatively impact feeding (sitting upright; head/trunk control; socialization during meals, trialing purees, etc).
    • Stage 3 -Fontan procedure between 2-4 years of age. The goal is to achieve normal oxygen saturations. This procedure is not completed until there is evidence of weight/growth between stages 2-3. Slow and diminished growth has a negative effect on the outcome of surgery.

Remember to ALWAYS collaborate and notify the cardiologist of ANY changes. A small change to you may make a big impact on their care.


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

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