Assessing oropharyngeal dysphagia in children: a comparative study of the Arabic version of the Pediatric Eating Assessment Tool and fiberoptic endoscopic examination of swallowing

Abstract Background While instrumental assessments like fiberoptic endoscopic evaluation of swallowing (FEES) are the definitive methods for diagnosing pediatric oropharyngeal dysphagia, caregiver-reported screening tools are essential for early triage. This study aimed to determine the direct predictive value of the Pedi-EAT-10 Arabic against specific FEES findings in children aged 6 months to 4 years. In a cross-sectional study, 52 children with suspected oropharyngeal dysphagia were evaluated. Caregivers completed the Pedi-EAT-10Arabic as a proxy report. FEES was performed by a specialized team using a standardized protocol with dyed boluses of varying consistencies (liquid, puree, and soft solids). Statistical analysis, including receiver operating characteristic (ROC) curves, was used to correlate Pedi-EAT-10 Arabic scores with four FEES parameters: premature spillage, pharyngeal residue, laryngeal penetration, and aspiration. Results The mean Pedi-EAT-10 Arabic score was 17.94 ± 9.67. FEES revealed high rates of laryngeal penetration (76.9%) and aspiration (75.0%), frequently occurring as co-occurring signs, while pharyngeal residue (17.3%) and premature spillage (15.4%) were less frequent. Pedi-EAT-10 Arabic scores were significantly associated with all FEES findings, showing the highest predictive accuracy for laryngeal penetration (AUC = 0.976) and aspiration (AUC = 0.995). A cutoff score of ≥ 13 demonstrated excellent discriminative ability for these safety risks. Conclusions The Pedi-EAT-10 Arabic is a potent predictor of pharyngeal-phase safety risks, particularly aspiration and penetration. While it does not replace instrumental evaluation for defining pathophysiology, its high sensitivity makes it a reliable triage tool for prioritizing children for urgent instrumental assessment and optimizing clinical resource allocation.