Int J Lang Commun Disord. 2026 Jul-Aug;61(4):e70278. doi: 10.1111/1460-6984.70278.
ABSTRACT
BACKGROUND: Flexible endoscopic evaluation of swallowing (FEES) is internationally recognised as an important instrumental assessment for paediatric dysphagia. Evidence supports its feasibility and safety in infants and children, but UK specific data remain limited. No published UK report describes a jointly delivered speech and language therapist (SLT) and paediatric otolaryngologist (ENT) FEES model applied across both neonatal and paediatric cohorts.
OBJECTIVE: To describe the implementation of a neonatal and paediatric FEES service delivered jointly by SLTs and ENT surgeons, and to evaluate clinical characteristics, FEES findings and subsequent changes to management.
METHODS: A retrospective audit included all children undergoing FEES between January 2024 and January 2025. Extracted data included demographics, comorbidities, referral indications, secretion management, penetration and aspiration events, swallow physiology, procedural tolerance and pre and post FEES feeding plans. Descriptive statistics were used to describe results. Governance approval was obtained through the hospital’s information governance office. (IG 2024-890).
RESULTS: Thirty-three children aged 4 days to 8 years underwent FEES. Comorbidities associated with dysphagia were present in 31/33 participants. Penetration or aspiration occurred in 21/33 participants, and secretion management difficulties occurred in 14/33 participants. Following FEES, 30/33 participants had a change to their feeding management plan compared with the plan developed based on a clinical feeding evaluation. No major adverse events occurred. One brief episode of mild epistaxis resolved spontaneously. The joint SLT and ENT model supported efficient scope passage and likely contributed to high procedural tolerance.
CONCLUSION: A neonatal and paediatric FEES service can be safely implemented in a UK tertiary hospital using a joint SLT and ENT model. Simultaneous upper airway examination alongside FEES provided clinically meaningful information that frequently changed management. Findings support further multicentre work to establish national paediatric FEES pathways.
WHAT THIS PAPER ADDS: What is already known on this subject FEES is a well-established instrumental assessment for paediatric dysphagia, providing objective insights into swallow function and airway protection. While widely used in countries like the U.S., Australia, and Canada, there is limited research describing paediatric or neonatal FEES in the United Kingdom or broader European context. Existing literature focuses primarily on feasibility and diagnostic accuracy, but does not address its implementation in UK public health systems or its integration with ENT services. What this study adds to the existing knowledge This is the first known study to describe the implementation of a joint ENT-SLT led paediatric FEES service within an NHS hospital. It identifies a high incidence of laryngomalacia during FEES, suggesting a potential association with oropharyngeal dysphagia even in the absence of classic airway symptoms. The study also demonstrates substantial variation in oral feeding plans post-FEES compared to bedside assessment, raising concerns about the standalone reliability of non-instrumental evaluations in neonates and infants. What are the potential or actual clinical implications of this work? The study supports routine inclusion of ENT in paediatric FEES, particularly for neonates, due to the frequency of structural airway anomalies such as mild laryngomalacia. It highlights critical limitations of bedside swallow evaluations as sole diagnostic tools and underscores the need for expanded access to FEES within the NHS. These findings reinforce the urgency for standardized UK-specific protocols and training pathways for neonatal and paediatric FEES to ensure accurate diagnosis and safe feeding management.
PMID:42324950 | DOI:10.1111/1460-6984.70278
