Instrumental assessment of swallowing in the context of breastfeeding

Abstract

Breastfeeding and its benefits are widely recognized, with exclusive breastfeeding recommended until six months of age. However, certain groups, such as children with dysphagia, face restrictions due to the risk of aspiration. Clinical assessment of swallowing in infants does not provide sufficient evidence to conclusively identify aspiration, making it necessary to complement the evaluation with instrumental examinations. Since the results of instrumental assessments performed during bottle-feeding cannot be extrapolated to breastfeeding due to physiological differences, there are currently no official guidelines for evaluating swallowing during breastfeeding.

Objective: To conduct a narrative literature review of recent experiences in the instrumental evaluation of swallowing in the context of breastfeeding.

Methods: A literature review was conducted covering the last ten years (2014-2024). Original studies and systematic reviews that assessed swallowing during breastfeeding using instrumental evaluations were included.

Results: Fifteen studies assessing swallowing during breastfeeding were identified, using four methods: videofluoroscopic swallow study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), ultrasound, and magnetic resonance imaging (MRI). In addition, six systematic reviews were included.

Conclusions: Information on swallowing and its disorders during breastfeeding remains limited. Establishing normative parameters for its evaluation is essential. Currently, FEES-Breastfeeding appears to be the most appropriate, safe, and accessible examination for clinically assessing swallowing in infants.