Preoperative anxiety in young children undergoing surgery is associated with a more painful postoperative recovery and a higher incidence of sleep and other problems.

Objective: To investigate the cliagnostic and rehabilitative u sefulness of routin fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric population.tudy Design: Prosp ctive, consecutive, blind d. Patients and Methods: Thirty pediatric inpati nts from a large, urban, tertiary care teaching hospital participated. Th ir ages ra nged from 11 days to 20 yea.rs (m an, 10 years and 4 months). In a random fashion, ev n ubj cts were asse ed with both vid otluoros opic valuation of swallowing (VFES) and FEE and 23 subj cts were as ssed solely with FE • • Diagno. i of dy phagia was determined by spillag , r s idu ·, la. ryng al p en etration, and aspiration. Rehabilitative . tl·ategies, .g., positioning and modification of bolu cons is tencie , were based on diagno tic findings. R srtlts: There was 100% agreem nt b tw n th blinded diagno tic r esults and impl m ntat.ion of r ebabilitative strategi es for subjects r andomly a ign d to r c ive both VFES and FEES and for subj ct who r c ived solely FEES. Of the 23 s ubj ct a s s ed sol ly with FEES, 13 of 23 (57%) xhibited normal swallowing and 10 of23 (43%) exhibited dy phagia. The feeding r ecommendation for 4 of 10 subj cts with dy phagia (40%) was for a non-oral di t becaus of a pi ration. FEES allowed for specific feeding r commendations (i.e., bolus consistency modifications, positioning, and feeding strategies) to r due aspiration ris k in 6of10 subj cts with dysphagia (GOo/ o). onclusion: FEE can b u ed routinely to diagno e and tr at pediatric dysphagia in the acute car , tting. Key Word : Deglutition, d eglutition disor·de rs, fib roptic endoscopy, pedjatric. 1 Fiberoptic assessment, using either a nalog or digital signals and especially when coupled with video capability, is the current technique of choi ce for examining the nasopha.rynx and la.rynx. La.ryn.g oscope, •3 A recent novel use of fiberoptic laryngoscopy has been to examine refl exive and volitional swallowing events in adults for both diagnostic and reh abilitative purposes, i.e., fiberoptic endoscopic evaluation of swallowing (FEES). 4 · 5 In adults FEES • 5 and videofluoroscopic evaluation of swallowing (VFES)6 -8 h ave been shown to be equ ally effective fo r the diagnosis of dysphagi a and the implementation of th erapeutic techniqu es to improve and promote safe swallowing. 5 · 9 -1 2 In the pediatric population , however, VFES has been the only objective technique used routinely for di agnosis of dysphagia and impl ementa tion of rehabili tative strategies. -18 FEES, being newer technology tha n VFES, has been slower to gai n widespread use in th e pedia tric population , but its potenti al a bi lity to diagnose and treat dysphagia in children is just as powerful as with adul ts.Transnasal flexible fiberoptic laryngoscopy is perform d routinely in children from birth to adolescence to evaluate an atomy and physiology of the upper aerodigestive tract to make medical diagnoses. 19 • 2 0 Only pilot da ta, however, have been reported on the use of FEES to diagnose and treat dyspha...

The 3-ounce water swallow challenge has been shown to be a clinically useful screening test for oropharyngeal dysphagia in children.