A videofluoroscopic swallow study (VFSS) is an X-ray that looks at how your swallowing works.  The procedure, sometimes called a modified barium swallow, involves swallowing a white powder called barium (mixed in with food and/or drinks) and then taking an X-ray.  A video recording is made that shows the food or drink moving over the tongue, through the pharynx (throat), and into the oesophagus (food pipe leading to the stomach).

A speech pathologist may recommend a VFSS for if there are concerns about how your child swallows, how the airway is protected during swallowing and/or how food moves from the mouth through the oesophagus.  A VFSS can help identify the reasons for the swallowing problem, and to determine if there are ways to keep swallowing safe.

A VFSS may be considered if your child regularly experiences any of the following:

• difficulty swallowing
• coughing during meals
• gurgly breathing during or after meals
• frequent choking
• chronic respiratory problems including chest infections or pneumonia.

How long will it take?

The procedure will take approximately 20 minutes.

Preparing your child for a VFSS

Your child will need to fast (no eating or drinking) for 3 hours before the VFSS. This ensures your child is hungry and wants to eat and drink during the study.

You are welcome to bring your own food/drink for your child to eat during the study.

If your child has any special feeding equipment (e.g., spoons, cups, bottles or teats) they normally use, bring them to the study.

Please advise your speech pathologist before the procedure if your child:

• is diabetic or you have concerns about fasting.
• has any food allergies/intolerances or food preferences.
• has specialised seating/positioning equipment requirements.

Important

• Do not dress your child in clothing with metal clips, snaps or zippers near the shoulders or neck.
• Remove all earrings and necklaces before the study.
• Pregnant mothers/carers cannot be in the X-ray room during the procedure.

What to expect

During the procedure

1. Your child will be seated in a special chair and will need to sit as still as possible. You will be able to stay with your child during the procedure.
2. A small amount of barium (a chalky, white, radio-opaque powder) is mixed with a variety of foods and drinks. The barium helps to outline the food and fluids more clearly in the X-ray.
3. A speech pathologist will ask you to feed your child different foods or drinks. If necessary, the speech pathologist or nurse may present these to your child.

After the procedure

After the procedure, the speech therapist will discuss the initial results with you and show you the video recording on a computer screen.  The recording will also be analysed in detail and shown to your child’s treating medical team, if necessary. A speech pathologist and radiologist will prepare a detailed report about your child’s swallowing function and treatment recommendations.

Are there any risks?

The risks and complications with a VFSS can include, but are not limited to, the following:

Common risks and complications

• Vomiting – requiring treatment with medication.
• Constipation – drinking extra fluids and laxatives can help with this.
• Diarrhoea causing dehydration – drinking extra fluids can help with this.

Less common risks and complications

• Pneumonia may occur if food/drink or fluid from the stomach goes into the lungs. This may require antibiotics and/or further treatment.

Rare risks and complications

• Allergic reaction to the contrast. This could result in a rash, hives, itching, nausea, fainting or shortness of breath. Medication can be given to relieve this.
• An increased lifetime cancer risk due to exposure to radiation from X-rays.

Developed by Medical Imaging and Speech Pathology departments, Queensland Children’s Hospital.

Resource ID: FS066 Reviewed:  March 2023

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.