June 2023 Pediatrics Newsletter

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. A few quick facts:

❖ We accept most insurances.

❖ We MUST have a signed order from a physician prior to initiating any contact with families. All orders should be faxed to 888.920.1201.

❖ I will personally call all families and the treating SLP (if applicable) prior to the study to gain a thorough history.

❖ In addition to faxing the full report to the referring physician & the treating SLP, I will also call/text the treating SLP following the study to give a brief synopsis.

Good News! We are now able to complete an MBSS in side-lying position for the infant population. We know that this is a beneficial feature, as many babies with dysphagia leave the hospital with recommendations for feeding in side-lying position. The machine can easily adjust between viewing the patient in side-lying and semi-reclined, so both positions can be assessed during one study.

Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm Infants with Dysphagia: A Pilot Study
by Ferrara, et al. Dysphagia (2018)

This study intrigued me because it was a great reminder that I can use this strategy during a swallow study in attempt to avoid thickener use or even upgrade a diet! While this is not a study involving a large number of participants (only 9 preterm infants with a GA <30 weeks at birth, to be exact), it is the only one of its kind in the pediatric realm.

Procedure: The infants were fed room temperature barium via bottle followed by chilled barium while an MBSS was administered. All 9 participants were observed to have pharyngeal dysphagia with the room temperature barium.

Results:

❖ All 9 participants presented with an absent cough response after each aspiration event.

❖ The ability to clear aspiration material from the trachea with subsequent swallow was greater in the patients given cold barium: 5/9 participants vs 1/9 participants given room temperature barium.

❖ The ability to clear the laryngeal vestibule following penetration was greater in the patients given cold barium: 6/9 participants vs 1/9 participants given room temperature barium.

❖ 7/9 participants presented with decreased number of aspiration events when offered the cold vs room temperature barium.

❖ Overall, the mean percentage of aspiration and deep penetration for all participants decreased when offered the cold barium vs the room temperature barium. Aspiration - from approximately 70% of swallows to <30% of swallows. Deep penetration – from approximately 80% of swallows to 45% of swallows.

❖ Occurrence of nasopharyngeal reflux was less frequent when offered cold barium, although not statistically significant in this study.

Rationale behind the use of cold liquids: The use of cold stimulation activates a greater number of thermoreceptors within the pharynx, which consequently provides larger levels of input to the brainstem. That input to the brainstem then sends signals to activate sequential muscular movements that assist with transportation of the bolus safely through the pharynx.

I encourage you all to read the whole article, as this was just a brief synopsis to stimulate our thoughts and conversation!

Do you have an interesting topic that you would like to share in this newsletter? If there is some interest, I would like to start a spotlight section each month featuring a topic from someone other than myself. If this sounds like something you would like to partake in, please email me!

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 ashley@diagnostex.us.

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!

Dates to Remember:

June 14: Flag Day

June 18: Father’s Day

June 19: Juneteenth

June 21: Summer Solstice