SEES: Can we use a scope to screen swallowing dysfunction?

When you think about using FEES (Fiberoptic Endoscopic Evaluation of Swallowing) in the pediatric population, do you go straight to figuring out how to coax a three year old to munch on some French fries while sitting very still with a camera in his nose? That’s not exactly a walk in the park! Is there even any point in attempting FEES with kids? On the other hand, FEES can give us some information that VFSS (videofluoroscopic swallow study) doesn’t provide and it doesn’t have the added considerations of radiation exposure. So where should a SLP in need of an instrumental swallowing assessment start?

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Meister et al. suggests starting with SEES. Yep, you read that correctly: SEES stands for Static Endoscopic Evaluation of Swallowing. This study looked at pediatric records from a clinic that had started implementing SEES.  Here’s how it worked:  patients (all the way from infants to preteens) were given one bolus to swallow (viscosity based on their current diet and clinical swallow evaluation) and immediately after, the scope was inserted transnasally. This allowed clinicians to visualize the larynx and take note of any residue in the pharynx or visible in the airway after the swallow. If patients were able to tolerate the scope, a full FEES assessment was completed, and all patients completed a VFSS.

By comparing the SEES results with the VFSS results, the authors were able to assess just how useful SEES is as a screening tool. Using gross residue on SEES, they were able to predict 80% of the patients who demonstrated deep penetration or aspiration on VFSS. (But if you’re doing the math, this means that using SEES as a screener would have missed 20% of the patients in this group who had deep penetration or aspiration.) However, in a full third of patients, SEES/FEES also gave the medical team important anatomical information that wouldn’t have been detected in a VFSS (e.g. vocal fold immobility and posterior glottic stenosis)!

Because of these results, the authors stopped short of endorsing SEES as a screener that could rule out the need for a full instrumental evaluation. Instead, they suggest starting with SEES and proceeding to FEES if the child can tolerate the procedure. Then, decide on your treatment plan (or ask for a VFSS) based on the FEES results. If the child is unable to complete the full FEES procedure, you would likely proceed to the VFSS. For all you visual learners, check out Figure 2 for a helpful decision tree. And if you’re wondering if SEES alone is ever appropriate, the discussion section has some great food for thought as to when this might make sense.

 

Meister, K. D., Okland, T., Johnson, A., Galera, R., Ayoub, N., & Sidell, D. R. (2019). Static endoscopic swallow evaluation in children. The Laryngoscope. doi: 10.1002/lary.28263

ChOMPS: A parent-report measure for children with feeding problems

Published in both our Birth to Three and Preschool & School-Age reviews this month.

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Ever wish for a parent-report measure to include as part of your evaluation and treatment of children with feeding problems? Thanks to Pados et al. we now have the Child Oral and Motor Proficiency Scale (ChOMPS) to assist us in gaining an objective assessment of eating and movement abilities. This checklist does NOT replace clinical assessment or provide a diagnosis, but it does help assess eating and related skills in children ages 6 months to 7 years. Sounds good, right? Well, it gets even better. The ChOMPS is available for free!* 

We’re going to review two related studies on the ChOMPS: the first study by Pados et al. details the development and content validation of this measure.

The ChOMPS was developed in four phases:

  1. Item generation based on existing literature and assessment tools

  2. Content validation with feeding experts

  3. Content validation with parents

  4. Readability testing

The ChOMPS was developed to help quantify what a child can or cannot do when it comes to observable eating skills like, “my child can drink from a straw” or, “my child can sit upright without support.” Parents can respond to these items by checking yes, sometimes, or not yet. The checklist was made in phase one and revisions to the checklist were made after phases two and three. This ultimately yielded a 70-item list written below a sixth-grade reading level. If you want more specific information on each phase be sure to click over to the article.

The next study, by Park et al., statistically analyzed the items on the checklist and evaluated the psychometric properties of the ChOMPS. A total of 364 parents of children with and without feeding problems completed the checklist. The authors used a statistical analysis (principle component analysis to be specific, more here for you stats whizzes) to determine subscales within the checklist. Based on the various analyses made by the researchers, seven items were removed. This left the researchers with a 63-item measure that represented four subscales: complex movement patterns, basic movement patterns, oral–motor coordination, and fundamental oral–motor skills. They also determined that the final version of the ChOMPS is both valid (e.g. differentiates children with vs without feeding difficulties, and subscales align as we’d want with tests like ASQ-3 and PROMIS) and reliable (e.g. test–retest—you’ll get the same or similar scores if you give it twice). Long story short, the ChOMPS is looking pretty good! 

So now what? Well, remember, this measure is not intended to replace clinical assessment or provide a diagnosis. However, we could pretty easily integrate it into our feeding evaluations and even use it to help evaluate a child’s response to intervention. For more information on norms by age, check out their 2018 paper. Also, keep your eyes peeled for a 10-question ChOMPS screener the authors hope to release in the near future. Thanks to these researchers we’ve now got a great new tool to add to our SLP toolbox! 

*This link connects you to several free feeding assessment tools, including the ChOMP’s complementary assessment the Pediatric Eating Assessment Tool (PediEAT). These measures were gathered together by a group called Feeding Flock. We have yet to review all of these measures because we just launched medical content. But stay tuned for some Throwbacks!

 

Pados, B.F., Thoyre, S.M., Park, J., Estrem, H.H., & McComish, C. (2019). Development and content validation of the Child Oral and Motor Proficiency Scale (ChOMPS). Journal of Early Intervention. doi: 10.1177/1053815119841091.

Park, J., Pados, B.F., Thoyre, S.M., Estrem, H.H., & McComish, C. (2019). Factor structure and psychometric properties of the child oral and motor proficiency scale. Journal of Early Intervention. doi:10.1177/1053815119841092.