Fiberoptic Examination of Swallowing in the Breastfeeding Infant

Objectives/Hypothesis: Fiberoptic endoscopic evaluation of swallowing (FEES) is the only instrumental exam that can be used to assess swallowing in a breastfeeding infant. There is minimal data on its efficacy and safety in this patient population. Analyze the common indications for, findings of, and safety of FEES exam in breastfeeding infants. Study Design: Case series. Methods: Consecutive 10 months old or younger breastfed infants undergoing a FEES exam between June 1, 2012, and August 1, 2014, at a university-based, tertiary care urban children's hospital were studied. Common indications for and findings of FEES, as well as complications of the procedure, were determined. Results: Twenty-four FEES were reviewed on 23 patients. There were 14 males (58%). The average age was 14 weeks, and two children were premature. Common indications for FEES were feeding difficulties (52%), noisy breathing with/without feeding (28%), and cyanosis (16%). Of the patients who participated in active breastfeeding during the exam, a functional swallow was identified in 12.5%. The remaining patients demonstrated dysphagia characterized by laryngeal penetration (83%) and/or direct aspiration (50%). The most common findings were laryngeal edema (29%), anterior displacement of glottis structures (14%), and cobblestoning (11%). There was no morbidity directly associated with the procedure. No cyanosis or respiratory distress occurred during or immediately after the procedure. Conclusion: Performing FEES exams on breastfeeding infants is safe and effective. There is no other instrumental evaluation of swallowing to assess dysphagia in this population.