Abstract
Aim: Videofluoroscopy swallow studies (VFSS) are gold standard to diagnose aspira￾tion in children but require resources and radiation compared with clinical feeding
evaluation (CFE). We evaluated their added value for diagnosis, feeding management
and clinical status.
Methods: A retrospective single-centre cross-sectional study of children aged
0–18 years, with respiratory morbidity, referred for VFSS at a tertiary pediatric
hospital.
Results: A total of 113 children, median age (range) 2.2 years (0.1–17.9), underwent
VFSS. Diagnosis included chronic pulmonary aspiration (CPA), 87 (77%); neurological,
73 (64%); gastrointestinal, 73 (64%) and congenital heart disease, 42 (37%), not mutu￾ally exclusive. Forty-six (41%) aspirated, 9 (8%) only overtly and 37 (33%) including
silent aspirations. Those with CPA or cerebral palsy were more likely to have VFSS
aspiration, OR 3.2 and 9.8 respectively.
Feeding recommendations after VFSS differed significantly from those based on prior
CFE, p < 0.001: The rate of exclusively orally fed children rose from 65% to 79%,
p = 0.006; exclusively enterally fed children from 10% to 14%; p = 0.005. During the
year after VFSS, there were significantly less antibiotic courses, total and respiratory
admissions.
Conclusion: In this population with high prevalence of clinically suspected CPA, VFSS
altered feeding management compared with CFE and may have contributed to subse￾quent clinical improvement.

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