Videofluoroscopic swallow test

Videofluoroscopy takes place in the x-ray department of Great Ormond Street Hospital (GOSH) and is an evaluation of the swallowing process. A recording is made of the moving (dynamic) x-ray showing swallows of food and liquid.

Why do we conduct videofluoroscopic swallow studies?

A videofluoroscopy swallow study (also known as a dysphagia barium swallow) is carried out to look closely at the swallowing process. Swallowing problems can show themselves in a variety of ways and may include:

  • coughing or choking when eating

  • weight loss

  • unusual frequency of chest infections or breathing difficulties

  • long mealtimes

Safe and efficient swallowing is the process where food and/or liquid moves from the mouth into the throat, and from there into the food pipe (oesophagus). As food and/or liquid moves through the throat, the airway closes to ensure nothing 'goes down the wrong way'. When swallowing problems occur, there is an increased risk of a small amount of food and/or fluid breaking off and entering the airway. This can be variable and may not occur with every swallow. Medical teams refer to this as 'penetration' or 'aspiration'. 

The purpose of this study is to take a close look at the swallowing process. This helps us define the problem and then recommend more efficient and safe ways of eating and drinking where possible. This will ensure that enough food or liquid is consumed in order to grow and develop healthily.

Is there anything I should do on the day of the videofluoroscopy?

As the study involves your child eating food and drinking liquid, it is important that your child is ready to eat and drink on arrival. They do not need to be starved, as there may be a wait in the x-ray reception or on the ward.

What do I need to bring?

  • food

  • drink

  • bottle/cup

  • spoon/bowl

  • supportive seating system (if applicable) 

Please discuss with your speech and language therapist any particular food or drink that it may be useful to bring.

What does the videofluoroscopy involve?

If you are a parent or carer, and wish to accompany your child during the swallow study, you will be asked to wear a lead coat. If you are pregnant or think you could be pregnant, please let us know before the test starts. As a precaution to protect your unborn baby from unnecessary radiation, we advise you to wait in reception until the study is over. Please bring another adult with you so someone can stay with your child during the test. If your daughter is 12 years old or older, we will ask her about her periods and any possibility that she could be pregnant.

Please also be aware, other children are not allowed in to the room where the swallow study happens. If you need to bring other children to the appointment with you, please bring another adult who can look after your children while you are in the screening room.

You are asked to bring your child’s usual food and drink to the appointment. We usually ask you to bring something they will find easy and something that can be more difficult for them to eat. A contrast material, usually barium sulphate, is mixed with the food and drink so that this will show up on the x-ray. This has a mild flavour and chalky quality that is usually masked by the flavour of food and drink. Barium is not absorbed by the gut – in fact you may notice this barium in your child’s stool one to two days after the study as it exits the body.

Your child will be asked to sit next to the camera, either on a chair provided by the x-ray department or in their own supportive seating system. During the study, your child will be asked to eat and drink as normally as possible while the camera is running. You are usually asked to stand in front of your child to help encourage them to eat/drink. The camera will make a noise as it takes pictures and may move up and down as it looks at different areas of swallowing. The camera will not touch your child.

As part of the study it may be useful to make changes such as changing their position, the food texture or utensils used. On some occasions it is helpful to do a ‘fatigue test’. This means that the camera is switched off for a short while, and the child is asked to continue to eat and drink. The camera is then restarted to look for any changes in swallow function which might occur as a result of fatigue. 

Who will be in the room?

Usually, there will be various people in the room: a radiologist (specialist doctor) who operates the equipment and helps the speech and language therapist to analyse the information, a radiographer and a speech and language therapist.

GOSH is a teaching hospital and there may be additional professionals within the room observing the procedure and being trained to carry it out.

If your child’s main difficulties include postural difficulties then an occupational therapist may also be present. If your child already knows a specific speech and language therapist within the speech and language therapy department, we try to ensure that he/she directs the study.

How long does it take?

The actual study takes several minutes to complete. Often time is needed to get the camera in the best position for the study. Therefore the whole process may take from 10 to 25 minutes in total.

What will happen once it’s over?

The speech and language therapist will review the recording and then meet with you to discuss the findings. Initial recommendations may be made at this time based on the findings. On some occasions it may be necessary to make a separate time to discuss the findings in more detail. 

Compiled by: 
The Speech and Language Therapy department in collaboration with the Child and Family Information Group, GOSH.
Last review date: 
April 2014
Ref: 
2014F0280

Disclaimer

Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.