Clinical Feeding and Swallowing Evaluation

We do a clinical feeding and swallowing evaluation (CSE) to see if your child has trouble swallowing (called dysphagia). During the evaluation, the therapist will observe your child eating and drinking in their typical manner in a treatment room. A speech-language-pathologist (SLP), occupational therapist (OT) or physical therapist (PT) will do the evaluation. During the evaluation, we will:

• Ask what concerns you have about your child’s feeding and swallowing.
• Ask about your child’s developmental and medical history.
• See how well your child can eat and swallow.
• Look at your child’s oral motor skills and chewing and the strength and movements of their muscles involved in swallowing.
• Look for risk signs that food or liquid could go into the lungs.
• Observe your child to see how their position, behavior and oral movements might affect eating and drinking. Try changing the food, liquid, position or how your child is being fed to see if the changes help.
• Provide feeding and swallowing recommendations and suggest next steps.
• Try strategies and techniques that might help your child’s individual needs. The SLP will also teach you about swallowing.

• Give your child their usual medicines.
• Bring your child hungry and willing to eat and participate.
• Do not give your child anything to eat or drink by mouth or by NG (nasogastric) or G (gastrostomy)-tube feeds for 2 hours before the appointment.
• If your child has ND (Naso-Duodenal)-tube or J (Jejunal)-tube feedings, please turn off feedings 1 hour before the exam.
• If your child is on a ketogenic or modified Atkins diet (MAD), skip the meal or bolus prior to exam or turn off the continuous tube feed 2 hours before exam.
• Please arrive 15 minutes before the exam to allow time for check-in.

Please bring the following:

• Familiar cups, bottles or any other special feeding items your child uses at home.
• Examples of your child’s familiar foods and drink. Then we can observe what your child typically eats.
• Any foods your child has difficulty swallowing. Then we can offer specific support.
• Therapy notes and therapist contact information if your child is currently receiving feeding and swallowing therapy.
• A 3-day food diary, if possible. Include what your child has eaten and drunk, amount taken, time it was taken and any reaction your child had (such as throwing up). If your child is tube fed, include those times and amounts as well.
  You can download and use our “3-day Food Intake Record.”
  seattlechildrens.org/pdf/PE1478.pdf

The SLP will consult with the provider who referred your child about next steps. This may include:

• Trial of different food or liquid consistency, position or feeding method.
• A referral to another clinic specialist at Seattle Children’s (such as pulmonary, gastroenterology or otolaryngology).
• Follow-up feeding therapy.

Your child may need other exams such as:

• A video fluoroscopic swallowing study (VFSS). In a VFSS, an SLP will work with your child to get an X-ray “movie” of their throat while they eat and drink. They will make recommendations right after the test, but you may need to check with your child’s doctor before changing their diet.
• A fiber optic endoscopic evaluation of the swallow (FEES) study. This is done with an ear, nose and throat (ENT) doctor and an SLP. It involves putting a small tube with a camera (scope) through your child’s nose to the back of their throat, so we can watch their structures and muscle function while they swallow.