Implementing a Neonatal and Paediatric Flexible Endoscopic Evaluation of Swallowing (FEES) Service in a Tertiary Children's Hospital in the United Kingdom: A Retrospective Clinical Audit
Alanna Thompson (nee Wagher), Jessica De Bolfo, Nicoll Bell, Louisa Ritchie, Stefano Di GioiaABSTRACT
Background
Flexible endoscopic evaluation of swallowing (FEES) is internationally recognised as an important instrumental assessment for paediatric dysphagia. Evidence supports its feasibility and safety in infants and children, but UK specific data remain limited. No published UK report describes a jointly delivered speech and language therapist (SLT) and paediatric otolaryngologist (ENT) FEES model applied across both neonatal and paediatric cohorts.
Objective
To describe the implementation of a neonatal and paediatric FEES service delivered jointly by SLTs and ENT surgeons, and to evaluate clinical characteristics, FEES findings and subsequent changes to management.
Methods
A retrospective audit included all children undergoing FEES between January 2024 and January 2025. Extracted data included demographics, comorbidities, referral indications, secretion management, penetration and aspiration events, swallow physiology, procedural tolerance and pre and post FEES feeding plans. Descriptive statistics were used to describe results. Governance approval was obtained through the hospital's information governance office. (IG 2024‐890).
Results
Thirty‐three children aged 4 days to 8 years underwent FEES. Comorbidities associated with dysphagia were present in 31/33 participants. Penetration or aspiration occurred in 21/33 participants, and secretion management difficulties occurred in 14/33 participants. Following FEES, 30/33 participants had a change to their feeding management plan compared with the plan developed based on a clinical feeding evaluation. No major adverse events occurred. One brief episode of mild epistaxis resolved spontaneously. The joint SLT and ENT model supported efficient scope passage and likely contributed to high procedural tolerance.
Conclusion
A neonatal and paediatric FEES service can be safely implemented in a UK tertiary hospital using a joint SLT and ENT model. Simultaneous upper airway examination alongside FEES provided clinically meaningful information that frequently changed management. Findings support further multicentre work to establish national paediatric FEES pathways.
WHAT THIS PAPER ADDS
What is already known on this subject
FEES is a well‐established instrumental assessment for paediatric dysphagia, providing objective insights into swallow function and airway protection. While widely used in countries like the U.S., Australia, and Canada, there is limited research describing paediatric or neonatal FEES in the United Kingdom or broader European context. Existing literature focuses primarily on feasibility and diagnostic accuracy, but does not address its implementation in UK public health systems or its integration with ENT services.
What this study adds to the existing knowledge
This is the first known study to describe the implementation of a joint ENT‐SLT led paediatric FEES service within an NHS hospital. It identifies a high incidence of laryngomalacia during FEES, suggesting a potential association with oropharyngeal dysphagia even in the absence of classic airway symptoms. The study also demonstrates substantial variation in oral feeding plans post‐FEES compared to bedside assessment, raising concerns about the standalone reliability of non‐instrumental evaluations in neonates and infants.