Modified Barium Swallow Study for Children: Technique and Utility

Barium swallow studies are used to assess dysphagia and should be modified for use in children. In setting up a modified barium swallow (MBS) study, the mutual cooperation of a speech pathologist, radiologist, and caregiver is ideal. This educational activity is aimed at assisting in the radiologist’s general understanding in preparation for MBS. Selection of barium consistency and delivery is critical to patient cooperation and the success of the study. The consistency of the barium contrast material is described in increasing viscosity as ultrathin, thin, slightly thick, mildly thick, moderately thick, and extremely thick. Selection should consider the patient’s diet. As a comparison, most infant formulas have a viscosity similar to thin liquids, while breast milk and water are similar in viscosity to ultrathin barium. Additives and modifications may be used to improve taste. Liquid modifications include flavored electrolytes, powdered juice, milk, or hot chocolate powder mix. Solid food modifications include barium cookies. In assessing the MBS, the 8-Point Penetration-Aspiration Scale and the Dysphagia Outcome and Severity Scale should be applied. The 8-Point Penetration-Aspiration Scale describes the entrance and clearance of barium material into the airway. The Dysphagia Outcome and Severity Scale is used to advise diet. These tools are useful in guiding the plan of action.