Barium Swallow test? - Mothering Forums
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#1 of 12 Old 08-21-2007, 12:42 PM - Thread Starter
 
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My 4 years 2 mos ds had a second opinion ENT visit today. The doctor said his frenulum is not too short and clipping it would not help his tongue move better since his tongue is short.

He mentioned that my son's hypotonia in his arms and legs affects his tongue as well. He also said swallowing affects speech. He mentioned having our pediatrician have us get a barium swallow test done.

If we know my son has swallowing problems what will this test achieve. Will it make a difference?

My son can eat and chew and nurse although he eats very little. Sometimes his vocal quality sounds wet like he needs to swallow. Up until he was 12 mos old he would vomit in a very irregular pattern after breastfeeding. (Maybe 3-5 times a week but no discernable pattern.)

The doctor said swallowing affects speech. I am going to talk to our SLP at todays speech session since her office also does swallowing therapy.

Any thoughts? Similar exeriences?

When I had my endoscopy I read about barium swallow tests and it will be vey difficult getting my son to drink that chalky liquid. I imagine we'll have to force him. Since it's not an emergency and he is gaining weight (36 pounds) it's a test we don't have to do.

Sincerely,
Debra, homeschooling mom of 4 ages 10 1/2 (AS), 9 1/2, 7 1/2, and 4 (Apraxia, Dysarthria, HFA, OCD)
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#2 of 12 Old 08-21-2007, 01:12 PM
 
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Well I'm not sure if this is the same or not but I have had upper GI's twice. The barium is yucky, no two ways about it, I also had to swallow something that in essence was like alka seltzer, can't remember the name of it, but it released a whole bunch of gas in my stomach to bloat it up so they could get good x-rays. That was not very pleasant either although I doubt your son would probably have to do that part if they are concentrating on the throat. I don't even know what to suggest other than a second opinion mama. I don't have any experience in this area other than the two GI series that I've had done. All I can say is that you are right, you are going to have ahard time getting the barium down your son.

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#3 of 12 Old 08-21-2007, 11:25 PM
 
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Originally Posted by AuntLavender View Post
If we know my son has swallowing problems what will this test achieve. Will it make a difference?

My son can eat and chew and nurse although he eats very little. Sometimes his vocal quality sounds wet like he needs to swallow. Up until he was 12 mos old he would vomit in a very irregular pattern after breastfeeding. (Maybe 3-5 times a week but no discernable pattern.)
The test could absolutely make a difference! The symptoms you described - eating very little and a wet voice are warning signs for potentially serious swallowing problems. A barium test is important so the doctors/SLPs can know what exactly is causing the problem. A child who is having swallowing problems can be aspirating - food or drinks can go into his lungs which can cause illnesses. Since most of the swallowing process happens inside the body, nobody can tell from looking at a person what is going on. With the swallow study, they can see what kinds of foods/drinks are giving your son trouble, what strategies might help, what foods/drinks are safe, and things like that.

I am not trying to scare you at all! Not every child with swallowing difficulties aspirates, or gets sick from it, but is definitely something that is worth checking out. It is just not possible to do a full eval without some way of looking inside at what happens during the swallow. It's great that he's gaining weight!

There are some Mamas here with a lot more experience with swallowing problems, they may be along to talk about their experiences. Good luck!
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#4 of 12 Old 08-21-2007, 11:53 PM
 
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During a modified barium swallow study, the SLP will mix barium in what your kiddo already eats (at least that's what we do) and take an x-ray when he is eating and swallowing and watch what happens to the food. It usually doesn't have to be a ton of food, just enough to get a few swallows on film to see what's going on. I would be concerned due to the wet voice after he eats. That means that there is liquid sitting at the top of his airway and he could be at risk for getting food/liquid into his lungs. They don't always go as planned. With a 4 year old, he may not be too cooperative, but I think it is worth the hassle. Another thing to remember too, is that we have done MBSs and have seen no aspiration, but all the signs and symptoms are there. It is always better to err on the side of caution when it comes to that, in my opinion.

Good luck. I am training to do these at work right now. Let us know how it goes.

Nena, Wife to S since 1995, mom to G (my wonderkid) since 2000 and R since 2006 (my snuggley boy who was diagnosed with mitochondrial disease in 2007)
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#5 of 12 Old 08-22-2007, 08:58 AM - Thread Starter
 
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and when he sounds wet it's not after eating or drinking. I think it's saliva. His SLP can get him to swallow and then he's fine.

He truly lives on air. Can they mix it with chocolate milk or soda?

I'll call my son's ped to discuss with her.

Thank you everyone for your thoughts!
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#6 of 12 Old 08-22-2007, 09:41 AM
 
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I agree that the swallow study, whether it's an upper GI (which my son had) or some more specific swallow test (as another pp's dc had) could be invaluable, because it could reveal reasons behind your son's difficulties, and maybe even give a clear and fixable diagnosis. But I'm sure your ped will tell you that!

My son had an upper GI and he totally refused the barium. He has a feeding disorder and there was no darn way he was going to drink a milky chalky liquid. I had to feed it to him bit by bit using a medication syringe. It was my least favorite test that he has ever had, but we got through it...
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#7 of 12 Old 08-22-2007, 11:06 AM
 
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The test can be extremely helpful because it will show you exactly what his tongue and mouth do when he eats so you and the therapist will in turn know how to help him.
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#8 of 12 Old 08-22-2007, 11:54 AM
 
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Another SLP here. The test may indeed be helpful diagnosing a swallowing problem and planning treatment, if necessary. However, be aware that it is an x-ray exposure. Be sure to let the radiologist know that you want the x-ray turned on for a minimum of time during the study. Most pediatric radiologists are good about switching it on and off as needed but some will just leave it on.

Some pertinent questions. Does your son cough or choke on food or liquid? Does he have a history of lung infections? Does he have trouble chewing foods? You don't mention what the ENT consult was for.

Also, you can request to be in the room. That may make it easier to get your son to take the bites/sips. Either way, barium should not be syringed into his mouth if he is unwilling to take it voluntarily. Involuntary introduction of material into the mouth does not show a typical chew or swallow, in my opinion.

One more thing. There are 2 distinct tests and you need to know the difference. A barium swallow test is also called an upper GI and it is often used to diagnose reflux. The person does need to drink a large amount of barium and lay flat on a table while being x-rayed to see if the fluid comes back up. A radiologist does and interprets this test.

A modified barium swallow test assesses the swallow from mouth to top of esophagus and also assesses any risk to the airway during the swallow. Only small bites/sips are needed to assess different consistencies. It will be best done by and radiologist and an SLP and the SLP will interpret the results. It is usually videod and you can ask to have the SLP go over the video and explain the findings to you.

Barium can be mixed w/ chocolate milk, chocolate pudding, put on a cookie. Soda probably won't work because the carbonation mixed w/ barium would produce and unusual consistency and it would be hard to make food recommendations based on results with that consistency.

Good luck making your decision. You are asking all the right questions.
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#9 of 12 Old 08-22-2007, 12:03 PM
 
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Just to clarify. I didn't mean to indicate that it was wrong for a pp to syringe barium into her child's mouth during a barium swallow test. For a barium swallow test that is fine because the test really looks at what is happening from the top of the esophagus to the stomach. For a modified barium swallow test, it's not a good idea, if the reason for the syringing is an unwilling child. That's because the test is assessing a typical swallow in the mouth/throat regions.
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#10 of 12 Old 08-22-2007, 01:09 PM
 
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Wow, I don't have any real advice, but I do remember dd having this done when she was 3 and it was not fun. She swallowed just enough for them to do the test, which was not very much. We didn't force her although we did use a little syringe after a while.

My thoughts are with you on that one - I wouldn't do it if you didn't really feel you needed to. It's not a lot of fun.

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#11 of 12 Old 08-22-2007, 05:11 PM - Thread Starter
 
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since my son is so unusual (no diagnosis).

I called the ENT doctor back and he is going to get me an appt with a GI doctor at Nemours and they'll order the test from there.

Thank you for your replies. I learned a lot from your experiences.

Sincerely,
Debra
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#12 of 12 Old 08-22-2007, 05:18 PM - Thread Starter
 
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Quote:
Originally Posted by maiat View Post
Does your son cough or choke on food or liquid?

Does he have a history of lung infections?

Does he have trouble chewing foods?

You don't mention what the ENT consult was for.
My son does not choke or cough on food or liquid.

He has never had a lung infection that I am aware of.

He doesn't appear to have trouble chewing food. When he does eat he can eat cheese, bagels, cookies, dry cereal, crackers, ice cream, milk, juice.

Today he nursed a little in the morning (9:45am) when he woke up (he's weaning). He ate some Teddy Grahams (6-8) and mozarella cheese (1 tsp). He had a few spoonfuls of cream of tomato soup for lunch. He ate some candy buttons. He drank some sips of Sprite. He's drank some water too. It's 4:06pm now.

The ENT consult was a second opinion for having his frenulum clipped. His tongue is short but his frenulum is not tight or too small. It's not holding his tongue down. The doctor said clipping it would not help. My son's SLP mentioned it when she said his vocal quality sounded wet during speech therapy. Other children where we go have had this done but I was not convinced it would help my son. We have decided not to do this. Then the second doctor mentioned swallowing affecting speech. So here we go again with more questions!

Sincerely,
Debra
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