When I think a client is having difficulty swallowing, I refer them to the doctor who then refers them for a video swallow study. A while ago, I referred a child who showed many signs of aspiration and was losing weight. He looked malnourished and everyone was concerned about him (including the dietitian and nurse). During the video swallow study, the client aspirated a bit. The radiologist and SLP doing the test were very concerned and said that he needed to be admitted to the hospital immediately for emergency tube feedings. It was surprising to me because I have seen worse video swallow studies and I work for a “client centered” agency. The choice to have a tube feeding inserted should be a team decision. This time it wasn’t and I was taken aback by it. The client was admitted to the hospital and I stayed with the family for a couple hours until they got things a bit settled. About a month later, he had the tube inserted (and was in the hospital the whole time).
Recently, I had to refer another child for a video swallow study. He has a degenerative disorder and his feeding skills have decreased dramatically in the last year. Because it can take him 20 minutes to eat a few spoonfuls of food, I was quite nervous for this video swallow study since it was at the same place. However, the test was done and the client did well. He didn’t aspirate at all (which surprised me) and no food or liquid was near the vocal folds either. There was residue (food/liquid in the mouth or pharynx after a swallow) but it was only mild to moderate. So, this client is doing better than I thought and can continue eating orally for a while. I am so relieved because I really thought that there was a possibility of emergency admittance again.
