Children's Hospital Colorado
Ear, Nose and Throat
Ear, Nose and Throat

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) Clinic

What is the FEES clinic?

The FEES clinic is a collaborative effort between Children’s Hospital Colorado’s Pediatric Otolaryngology Department and the Swallowing Disorders Clinic. In the FEES clinic, a multidisciplinary team including otolaryngology (ENT), speech pathology, occupational therapy and nursing personnel evaluate a child’s feeding and swallowing skills. Children who are referred to the FEES clinic typically have a diagnosis of or suspicion for dysphagia, or difficulty swallowing. These children may have difficulties with aspiration or passing of liquid and/or food into the lungs.

The purpose of the FEES clinic visit is to evaluate the child’s feeding and swallowing function. This is accomplished through caregiver interviews, observation of the child while eating and direct visualization of the swallowing structures using a pediatric endoscope. The endoscope is a thin, flexible tube that is attached to a bright light and a camera. The thin tube is passed through the passages in the nose, which allows the team to view the structures of the upper aerodigestive tract (inside of the nose and throat) and how they function during swallowing and at rest.

Our evaluation is intended to help identify risk factors for aspiration and adaptations (such as changing the child’s position, type of bottle or cup or consistency of food/drink) to increase the safety of drinking and eating. The goal of the evaluation is to determine the safest way for the child to take food and/or liquid in order to decrease health risks that may occur from aspiration (such as lung problems).

The FEES clinic is sometimes an alternative, and at times a complementary evaluation to more traditional methods of swallowing evaluation, such as the Upright Modified Barium Swallow. FEES does not involve radiation, can be done in any exam room in virtually any patient position and is well tolerated by the majority of patients. Children of any age may be referred to the FEES clinic. Records will be reviewed by team members to determine if this is the most appropriate evaluation for the child and the FEES clinic scheduler will assist the family in scheduling and preparing for the visit.

Why choose Children’s Hospital Colorado?

The FEES clinic combines pediatric expertise in otolaryngology, speech pathology and occupational therapy to provide the most child and family-centered evaluation of swallowing available. Our experience with children and our pediatric-sized equipment uniquely qualify us to provide this service.

What to expect in the FEES clinic

A visit to the outpatient FEES clinic is approximately one hour long. A typical visit includes the following:

  • Caregiver interview during which team members ask about the child’s medical history and caregiver concerns regarding the child’s feeding and swallowing
  • Observation of the child while eating and drinking
  • A brief endoscopy procedure is performed, during which the inside of the child’s nose is numbed with a spray anesthetic (pain medication) and a flexible, narrow endoscope is placed in the patient’s nose. The child may be asked to talk, cough and eat or drink with the scope in his/her nose. If the child eats or drinks, the food and liquid is dyed blue to help the evaluators see it easily on the screen. The child (if able) and caregiver can observe the procedure as it is happening on a screen. The procedure lasts anywhere from a less than a minute to approximately 5 minutes.
  • Results of the FEES evaluation are shared with the caregiver and child (if developmentally appropriate) at the conclusion of the visit. A brief report is handed to the family before they leave, including recommendations for the safest diet for the child.
  • A longer report is sent in the mail within 1 to 2 weeks of the visit.
  • The child will be referred to outpatient nutrition services if further evaluation or intervention is needed to address growth or nutrition.

Many caregivers have questions about whether their child will tolerate the endoscopy portion of the FEES evaluation. Our team makes a significant effort to ensure that this part of the evaluation is as comfortable as possible for the child. Numbing medicine is sprayed inside of the nose before the evaluation. The endoscope is a pediatric-sized scope designed for use in children. This portion of the visit is uncomfortable, without being painful, and often lasts just a few minutes. All of the providers in this clinic have personally experienced the scope procedure themselves. It is brief and feels strange, but does not hurt. Nevertheless, most children do cry some, and this is normal and expected. If you feel that your child will not tolerate this procedure well, please contact our scheduler in advance and we will make an effort to connect you and your child to a therapeutic recreation/child life specialist who can provide suggestions for making this easier.