If anyone would ever have the chance to observe a video fluoroscopic
swallow study, you will be glad you took the time to do so.  When an
infant, or someone of any age, aspirates, you actually SEE the liquid
going into the trachea as opposed to the esophagus.  You may also see
what is called PENETRATION.  Penetration is not aspiration but in some
cases, may progress to aspiration but not necessarily.  Penetration many
times does not require intervention unless it progresses to aspiration
further into the feeding.  The VFSS is an objective study, not
subjective.  What the study below states is that the VFSS is more
accurate than a clinical observatipn of symptoms such as cough, choke,
desaturation, wet or congestion audible and is better able to diagnose
and assist with finding most effective treatment.  Adjustments in
position, changing the flow of the liquid by various means should be
attempted to find an effective feeding plan considering the most benign
in risk.  When you slow that pace of feeding, starting with paced
swallows, slower flow, advancing texture etc... you SEE that the
aspiration is no longer occuring.  I am not sure what more evidence is
needed with that objective information.  The food needs to be kept out
of the lungs.  As I had mentioned in previous posts, there may be
situations that feeding at breast may be paced by mother when infant is
not selfpacing to maintain a safe airway.  There are situations that
thin liquids are just not safe and require a thickened texture and also
times that any feeding is not safe requiring no oral feedings.  I found
a nice site with evidence based info...  The multidiscipline approach is
very similar in my facility except for the pharyngeal swallow motility
study.  We do not have that ability.
http://www.nationwidechildrens.org/GD/Templates/Pages/MedPros/Profession
alPublications/PrinterFriendlyPage.aspx?page=5496&PageRefId=5492&Content
Id=41547 I have no idea if this link will go through to the list.
Angie Kirkwood RN BSN IBCLC RLC


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