CREDIT:
Earn 3 contact hours (0.3 CEUs)
COURSE DESCRIPTION:
This advanced-level session explores the often-overlooked esophageal phase of swallowing and equips clinicians with the tools to identify, differentiate, and respond to esophageal dysphagia in medically complex young children. Topics include esophageal dysmotility, gastroesophageal reflux disease (GERD), eosinophilic esophagitis, strictures, and congenital anomalies (such as tracheoesophageal fistula and esophageal atresia), diagnostic procedures, and SLP instrumental swallowing evaluations (VFSS & FEES).
LEARNING OBJECTIVES:
- Relate esophageal anatomy and physiology to infant and toddler feeding
- Identify clinical signs suggestive of esophageal dysphagia and distinguish them from oropharyngeal and behavioral feeding presentations
- Determine the purpose and limitations of relevant diagnostic tools including VFSS, FEES, esophagram, upper GI series, pH/impedance studies, and endoscopy
- Effectively collaborate with medical professionals by documenting and communicating red flags and therapy outcomes
- Identify strategies to educate and support caregivers during the diagnostic and referral process for esophageal concerns
AUDIENCE:
Therapists working with the birth to three population.
SCHEDULE:
1.1 Introduction and Framing the Problem
- Presenter introductions
- Course overview and goals
- Scope of the therapist’s role in recognizing and responding to esophageal concerns
- Discussion: “What do you do when a child has a normal swallow study, good oral skills, and yet still shows signs like mid-feed arching, vomiting, or refusal? How do you know when to suspect esophageal involvement?”
- Discussion of common clinical scenarios that suggest deeper investigation
- Why esophageal dysphagia is underrecognized in pediatric feeding therapy
1.2 Anatomy and Physiology of the Pediatric Esophagus
- Esophageal anatomy: UES, esophageal body, LES
- Differences in infant vs. adult esophageal function
- Role of esophageal motility and coordination in feeding
- Suck–swallow–breathe–esophageal transit: integrated timing in infancy
- Reflux susceptibility and immature LES tone
Therapist Takeaway: Understanding esophageal function supports better observation and advocacy.
1.3 Etiologies of Esophageal Dysphagia
- Structural causes:
- Tracheoesophageal fistula/esophageal atresia (TEF/EA)
- Strictures, rings, webs, laryngeal cleft (type I or II)
- Inflammatory causes:
- Gastroesophageal reflux disease (GERD)
- Eosinophilic esophagitis (EoE)
- Functional causes:
- Esophageal dysmotility
- Delayed emptying
- Esophageal spasms
- Post-surgical contributors(e.g., scarring, narrowing, repair complications)
- Prolonged NGT useand iatrogenic changes
Case Highlight: Child with repaired TEF and persistent feeding issues despite therapy
1.4 Clinical Signs and Red Flags: What Therapists Observe
- When oral phase appears functional, but the child:
- Becomes distressed or refuses partway through a meal
- Regurgitates undigested food post-meal
- Coughs or sounds wet after—not during—swallow
- Arches, cries, or vomits during or after feeding
- Struggles to advance textures
- Has poor weight gain or inconsistent feeding volume
- Contrasting with:
- Oropharyngeal signs (e.g., coughing during swallow, aspiration)
- Behavioral feeding issues (e.g., refusal without physiologic distress)
Therapist Role Discussion: Observing patterns across sessions, feeding contexts, and caregiver reports
2.1 Instrumental Studies: What Therapists Need to Know
- SLP-Led Studies
- VFSS (Modified Barium Swallow Study):
- Primary focus: oral and pharyngeal function
- Esophageal observations: hold-up, retrograde flow, delayed clearance
- Phrases to use in reports/notes
- FEES:
- Limited to pharyngeal view
- Red flags that may point to esophageal issues (e.g., pooled secretions, multiple swallows with no residue reduction)
- Medical Diagnostics (For Awareness and Collaboration)
- Esophagram vs. Upper GI Series:
- What each shows and when they’re used
- EGD (Endoscopy):
- How it identifies inflammation, narrowing, EoE
- pH Probe / Impedance Studies:
- Evaluates reflux (acid and non-acid)
- Manometry:
- Rare in infancy; assesses motility
Takeaway Chart: Purpose, strengths, and limitations of each test—designed for therapist use
2.2 Documenting Red Flags and Feeding Therapy Outcomes
- How to support a referral with:
- Language describing lack of progress
- Clear symptom timelines and feeding patterns
- Specific observations: e.g., “refusal after initial engagement,” “post-feed emesis despite adequate oral intake”
2.3 Caregiver Communication and Team Advocacy
- Coaching caregivers through what you’re seeing
- Responding to “they already had a swallow study and it was fine”
- Using language that is clear but not alarming:
Ex: “We’ve looked at how food moves through the mouth and throat. Now we’re thinking about how it moves through the rest of the digestive tube—the esophagus.”
3.1 Comprehensive Case Study Walkthrough
Case Scenario:
- 10-month-old with safe VFSS results, oral feeding skills improving, but ongoing post-meal vomiting, mid-feed refusal, and poor weight gain
Facilitated Clinical Reasoning:
- What has been ruled out?
- What red flags suggest esophageal involvement?
- How would you modify your feeding therapy plan?
- How would you document your clinical concerns and outcomes to support a referral?
Therapist Reflection Prompt Discussion: “What’s within your scope—and what’s your next step?”
3.2 Interdisciplinary Collaboration and Practical Strategies
- Working with PCPs, GI, ENT, radiology, and dietitians
- Feeding clinics vs. fragmented referrals
- What to do when medical providers dismiss therapist input
- Feeding therapy adaptations while awaiting medical work-up:
- Pacing, positioning, thickening, smaller volumes, pre/post-feed observation
- Counseling families on safety and symptom tracking
Discuss Sample Workflow: From therapy concern to GI referral with coordinated documentation and parent support
3.3 Case Study Activity: Plan with Purpose
Scenario:
6-month-old with NGT history, mild reflux, gags and vomits during spoon feeds, feeding therapy attempted for 3 months without progress. VFSS shows no aspiration.
In Discussion (using collaborative and interactive visual aids):
- Identify red flags
- Modify therapy plan for safety
- Draft 1–2 documentation phrases to support referral
- Prepare 1 caregiver talking point
Participants share one key recommendation or documentation strategy.
3.4 Final Takeaways
- Top 5 therapist-recognizable signs of esophageal involvement
- Key documentation do’s and don’ts
- Reinforcement: Observations and advocacy matter
Post-test
Anais Villaluna, SLPD, CCC-SLP, BCS-S, CLC is a trilingual Speech-Language Pathologist and Board Certified Specialist in Swallowing and Swallowing Disorders. She earned her Bachelor of Science (2006) and Master of Science (2008) degrees from Texas Woman’s University and completed her clinical doctorate (SLPD, 2025) at Northwestern University. She is currently pursuing a PhD in Health Services Research at Texas A&M University, focusing on improving the implementation of evidence-based care for pediatric dysphagia.
Anais practices in a variety of pediatric hospital settings, including pediatric hospital inpatient units, outpatient clinics, and multidisciplinary specialty clinics with gastroenterology and otolaryngology teams. Her clinical work is centered on medically complex infants and children with feeding and swallowing disorders, and she is passionate about translating evidence into practice to improve care quality and outcomes.
She has presented nationally and virtually on topics related to pediatric dysphagia, culturally responsive practice, and implementation science, and is a published author in peer-reviewed journals. Anais also holds leadership roles with organizations such as the International Dysphagia Diet Standardisation Initiative (IDDSI) and Feeding Matters. Her work emphasizes interdisciplinary collaboration, clinician education, and ethical, system-level change to advance pediatric dysphagia care.
Financial Disclosure: Anais Villalluna receives a salary from Texas Children’s Hospital and Feeding and Swallowing Specialists of The Woodlands. Anais Villaluna receives an honorarium from Education Resources, Inc.
Non-Financial Disclosure: Anais Villaluna has a non-financial relationship with IDDSI (International Dysphagia Diet Standardization Initiative) as a US IRG Pediatric Co-Chair, Communication Committee Member. Anais Villaluna has a non-financial relationship with Feeding Matters as a volunteer for Digital Outreach Committee.
Dr. Chu serves as an attending physician in Pediatric Gastroenterology at Texas Children’s Hospital and is Associate Professor of Pediatrics at Baylor College of Medicine. He believes that building strong partnerships with families and care providers is crucial to fully leveraging the resources of health systems to care for children with chronic feeding disorders and other complex medical issues. Together with Anais Villaluna, he serves as co-director for the Multidisciplinary Feeding Clinic at Texas Children's Hospital The Woodlands, a collaborative initiative involving Speech Language Pathology, Occupational Therapy, Gastroenterology, and Nutrition to provide outpatient evaluation and management for children with chronic feeding difficulties.
He also serves as co-director for the Multidisciplinary Abdominal Pain Program (MAPP) at Texas Children’s Hospital, which provides evaluation and management for children with disorders of gut-brain interaction (DGBIs, also known as functional abdominal disorders). Dr. Chu has been recognized by Baylor College of Medicine and Texas Children's Hospital with some of their highest clinical recognitions for his clinical care, including the Department of Pediatrics Chair's Outstanding Clinician Award and the Ambulatory Practitioner Award for Excellence in Patient Experience.
Once you purchase an online course you will have access to the course materials. If you have purchased this course, please ensure you have logged in to your account in order to take the exam.
Once you purchase an online course, you will have the opportunity to take an exam to test your retention of the material. If you have purchased this course, please ensure you have logged in to your account in order to take the exam. The exam must be completed with a pass rate of 80% or more in order to receive your certificate of attendance.
