Swallowing (Dysphagia) Screening

What is the Purpose of a Swallowing (Dysphagia) Screening?

Swallowing screening identifies those infants, children and youth with the greatest risk of having swallowing difficulties so that they may be referred for a clinical swallow evaluation or instrumental swallowing evaluation if indicated. By definition, screening is not diagnostic. Unlike clinical or instrumental swallowing evaluations, screening does not provide information about airway protection, dysphagia severity or best management. (American Speech-Language-Hearing Association, 2019); (American Speech, Language, & Hearing Association, 2004); (Swigert, 2019).

CONSIDERATIONS FOR SWALLOWING SCREENING

    Who should be screened?

  • Any infant, child or youth with aspiration risk concerns

    Who could initiate a discussion for need of a swallowing screen?

  • Parents, caregivers, and healthcare professionals

    Who could complete a swallowing screen?  

  • Parents
  • Healthcare professionals

Screening Tools for Swallowing (Dysphagia) Risk

Validated tools that screen for swallowing risk serve to (Speech Pathology Australia, 2012); (Stewart, 2003):

  • determine aspiration risk (see Table 1)
  • improve awareness of swallowing risks and impact on hydration and nutrition
  • detect unsafe airway issues
  • ascertain the need for a comprehensive assessment to determine anatomical or physiological abnormality
  • provide a referral method for a comprehensive assessment

Recommended tools for families to screen for swallowing risk include:

  • Feeding Matters Infants and Child Feeding Questionnaire© (Silverman, Berlin, & Linn, 2020)
  • The Pediatric version of the Eating Assessment Tool (PEDI-EAT-10) (Arslan, Kilinc, Yasaroglu, Demir, & Karaduman, 2018)
  • Parent-Reported Outcome Questionnaire for Swallowing Dysfunction in Healthy Infants and Toddlers  (Baqays, 2020)

 

Table 1: Indicators that Child is at Risk or may be Aspirating

Signs and Indicators of Possible Aspiration
(consider secretions, solids eaten and liquids taken orally or by tube):

OVERT SIGNS

SUBTLE SIGNS
  • choking
  • gagging
  • coughing
  • refusing to feed
  • wet or gurgly voice during or after feeding
  • hoarse voice
  • drooling or pooling of secretions
  • apneas or desaturations with feeds
  • noisy breathing
  • physiological instability
  • watery eyes
  • sudden state or tone changes
  • ongoing need for supplemental oxygen or increased oxygen needs
  • recurrent, frequent respiratory infection
  • poor weight gain
  • minimal oral intake/lengthy feed times
  • fatigue with feeding
  • nasal flaring
  • colour changes

(NSW Office of Kids and Families, 2016)

Note: Aspiration can also occur in the absence of signs or symptoms.
Any observation of the preceding should be referred immediately for further investigation.