Videofluoroscopic investigation of feeding disorders of children with multiple handicap.

Ten patients aged from nine months to 24 years with severe physical and intellectual impairments who had feeding difficulties were investigated by videofluoroscopy of repeated modified barium swallows. In all but one case the swallow reflex was delayed, and seven had poor and inefficient pharyngeal peristalsis. Four aspirated large amounts and three small amounts, all tending to do so with pastes rather than liquids. Recommendations, based on the videofluoroscopic findings, included changes in body and head position and consistency of food and of feeding technique. There were noticeable improvements in meal-time behaviour and reduced coughing and choking.