Dynamic evaluation of swallowing in pediatric patients with dysphagia: The Brazilian perspective.

Dynamic Evaluation of Swallowing (DES) is an exam which provides invaluable information on the swallowing function. This review describes the requirements, protocols and processes for DES in regions of Brazil. Dysphagia is a swallowing abnormality, in one or more swallowing phases, with risk and/or occurrence of aspiration, damage regarding nutrition and/or hydration and possible need of nonoral feeding methods. DES is performed in an armored room, using fluoroscopy, with the patient in lateral and anteroposterior views, in an orthostatic position. Different consistencies and volumes are tested, depending on the patient's age, complaint and clinical conditions. Its main objective is to determine if the patient can safely eat orally, is able to meet his basic nutritional and hydration needs, or if alternative means of feeding are necessary. It allows anatomical observation of structures, and the dynamics of swallowing during oral, pharyngeal and esophageal phases, in real time. The DES is used worldwide for pediatric patients, from newborns to adolescents, for a complete assessment. In Brazil, the exam is the state of the art in the functional evaluation of swallowing, however it is only available to a fraction of the population, mostly in the largest, and economically developed cities, and usually restricted to major health centers and teaching hospitals. Implementing DES in healthcare units requires radiological equipment, infrastructure standards, availability and training of personnel, as well as specialized physicians, and speech-language pathologists. For these reasons, our services face daily challenges while managing long scheduling waiting lists.