Implementation of Child Life Specialists to improve outcomes in flexible endoscopic evaluation of swallowing in children

Background: Dysphagia and feeding difficulties are common problems in children, and Flexible Endoscopic Evaluation of Swallowing (FEES) is a modality for evaluating pharyngeal swallow function through a transnasal flexible fiberoptic laryngoscopy. Objective: Due to the concerns around participation and its impact on successfully completing FEES in children, we began utilizing Child Life Specialists (CLS) for FEES procedures and a concurrent implementation research study was launched to measure the impact CLS interventions had on participation rates of children undergoing FEES. Methods: A retrospective chart review was conducted, collecting patient demographics, participation rates and presence of CLS for all FEES conducted in the study period. To compare children undergoing FEES with the benefit of CLS and those without a CLS present, two by two comparisons were conducted using Student's T-test and Pearson's Chi Squared test. Results: During the study period 196 children had a FEES with a median age of 2 years (range 2 weeks-17.8 years). Overall, 89 % of children cooperated with the procedure, and in children over the age of 5 years, 99 % of children cooperated. Presence of CLS did not seem to affect cooperation rates in our study. Conclusion: The addition of CLS services to the FEES team did not appear to improve participation rates in the current study, however more subtle potential impacts on procedural satisfaction/comfort were not assessed. Our results point to the need for additional work to standardize protocols in pediatric FEES to ensure not only improved participation, but a comfortable patient/family experience.