The order in which the textures are offered should be case dependent. Starting with a less chal­lenging food can permit observation of patterns they may consider normal when there are, in fact, signs of dysfunction. Ask the child to describe what they feel while swallowing. The parents can also provide a historical account of what reactions occur with spe­cific textures. In the case of profound dysphagia, it may only be safe to work on secretion management and taking small ice chips or sips of water without audible vocal wetness or involuntary coughing.

Not all pediatric dysphagia consultations will require an instrumental evaluation. It is particularly important to ensure functional information will be gleaned from the exam, which may be distressing or expose them to radiation. If a child does not have pulmonary concerns, modifying textures and behaviors while eating may be the intervention

infant.

FEES does not pose exposure to radiation like a fluoroscopic swallowing study. It allows for longer exams as tolerated by the child. The utility of a longer exam is trialing multiple textures, pos­tures, learned techniques, and stamina throughout a meal.

Caring for children with feeding and swallowing disorders is a clinical specialty. Pediatric condi­tions are unique from adult situations as they may be a congenital structural anomaly, neurological, developmental, or behavioral. The underpinning of dysphagia can be an early sign of a more wide­spread disorder or syndrome that is not yet diag­nosed. Depending on the child’s age and cognitive status, clinicians will interact heavily with parents and caregivers. Integrating children into the care plans will ultimately enhance their motivation. Cre­ate therapy goals collaboratively that include realis­tic goals, have distinct rationale, and are inherently motivating. For medically complex children, they will have numerous providers. Often, care delivery for children, especially those who are critically ill, is provided in a multidisciplinary model. Aim to avoid redundancies in prescribed exercise regimens as they may have numerous care plans implemented at home. Maintaining fluid conversation among cli­nicians improves outcomes and can be intellectually stimulating as elements of a child’s care will inevita­bly cross over into other specialty domains. Bear in mind the potential for serial instrumental exams and use them sparingly in younger children who may become sensitized or fearful of objective studies. Observation of feeding and swallowing behavior, medical history, and family reports are key elements to diagnostic interactions and developing effective care plans.

1. Describe the interactive nature of a feeding and swallowing disorder for an infant with pathological gastroesophageal reflux.

2. How can you support children with tracheos-