Swallow Studies: What are they? How do you advocate for your loved one?
Hi everyone! Sorry, there was so much time between posts. In 2025, I am going to get better at this. Today’s topic swallow studies (MBSS)! Feeding & eating is on of my specialties and a preferred topic for the clients I work with almost every day. This is such a HUGE topic for so many in the disability community and their parents/caregivers. Today, we are going to talk about different ways you can advocate for you child or adult person you are caring for so that they can receive the best quality care and personalized services that they deserve.
Some diagnoses that this information may be helpful are; cerebral palsy, TBI, aspiration risk, swallowing difficulties, dysphagia, senses impairment (weather this is scent, hearing, taste, or sight), dissociative identity disorder (DID), depression, anxiety, autism, ADHD, down syndrome, and sensory processing disorder (SPD).
Now there may be more diagnoses that I didn’t list that this could be beneficial for, but above is just a general list. Since feeding education contains SO much information, for the purposes of this post we will start with once children are allowed to get off of milk and between solids or purees (about 6 months and up), however you can do swallow studies occasionally at younger ages.
The first thing to consider is can my child/person swallow safely? – If the answer you know is already a no or I’m not sure, then you want to find a reputable place to do a swallow study. (MBSS Swallow Study). The main discipline that performs these are speech language pathologists. If you want to know specific places that I recommend, please send me an email: holly@canoecommuntiy.org.
You do NOT WANT a feeding evaluation first if the person has shown choking, gagging, cannot clear their own secretions, wheezing sounds, or a history of aspiration pneumonia. Why would I say that? Well – I won’t repeat all the horror stories, but some professionals have recommended this first and I will just say it has in some cases led to heavy vomiting, discomfort, and occasional food coming out the child’s nose. When children or people have disabilities and you care for them every day 24/7, that could be a horrifying experience that no body deserves.
A swallow study is a short or long test (depending on the child’s comfort) where they have the child eat small portions of food with barium (X-ray substance) against a moving X-ray machine. The therapists and sometimes doctors will then watch the screen and help access what is going on inside when someone swallows. **Pro tip: You only need a few swallows to see what’s going on for each type of food. There is no need to force anymore food after that if the child is no longer willing to participate.** Barium doesn’t taste good. Who’s got a picky eater? You know as well as I do that you might only be able to get 3 bites before they not longer wish to participate. **Pro tip: Find a place that let’s you bring favorite foods from home to encourage participation. There should be ZERO reason why you cannot bring their preferred foods UNLESS you have already be deemed NPO (nothing per oral).**
After the study is done, a good therapist will give you a summary of what is safe to consume orally, but this could take up to a week. They will give you limits on textures, solid vs. liquid, volume of food, and speed. Therapists observe something called “penetration”. This is whether or not food penetrates the larynx (what we breathe with) when a swallow is performed. Hint Hint, we are supposed to have zero penetration when swallowing. So, a really smart question to ask when you are back in the room with your big X-ray vest on for prevention of radiation is, “[Therapist Name], was there any penetration that I should be worried about when we go home today?”.
Asking this prompting questions can be VITAL for recommendation when you go home while you wait for the formal report. They will be able to tell you if it’s even safe to give your person your caring for food or drink.
Once you have the report, a speech therapist OR occupational therapist (which I am partial to obviously) trained in feeding and eating can read this swallow study and help provide care that is appropriate for your person. Once that feeding therapist has worked with them and shown progress, you can always go back for another swallow study to see if swallow progress has been made and you can release restrictions, etc.
Swallow studies are often seen as VERY intimidating by the clients and the caregivers. If you’re looking to get a swallow study to make sure your loved is safe when eating please consider calling and asking the facility the following questions BEFORE confirming an appointment, insist on talking to the therapist performing and reading the test.
1. I am looking to get a MBSS swallow study for my loved one, do you provide that service?
2. Can I bring my loved one’s preferred food for this study? **Small exception is that some loved ones need sterile or near sterile food, that would be the only reason that this would be a no.**
3. My loved one is very picky and I know they won’t like the taste of Barium, can I confirm with you that the test will be stopped at first signs of my loved ones unwillingness to continue?
4. Can I feed them myself because they won’t take a spoon from anyone else?
5. Can we come and see the room before the test and practice sitting in the chair so it is a familiar place?
6. Will you be sending me a report afterwards will all the information about how my loved one did so that I can share results with our feeding team?
THE ANSWER TO ALL OF THESE QUESTIONS SHOULD BE YES!
When getting a test done, it is so important that EVERYONE is comfortable in the process, familiar with the environment, and although we know they won’t like the taste, we can hopefully count on 2-3 bites to get the information we need. Have additional questions about swallow studies? Email me: holly@canoecommunity.org
Until next time! I hope you all found this helpful!
Holly Ross
OTR/L, WSI/T, LTP, ATRIC
