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Scientific Oral Presentation

Pediatric Otolaryngology

Optimizing Videofluoroscopic Swallow Study (VFSS) Timing Following Pediatric Viral URI for High Value Dysphagia Management

Tuesday, October 20, 2026
9:09 AM - 9:15 AM PT
Location: 409AB

    Presenting Author(s)

  • MK

    Maheen Kara, MBA

    Medical Student
    Baylor College of Medicine
    Houston, Texas, United States

    • Senior Author(s)

  • Nikhila P. Raol, MD, MPH

    Associate Professor
    Baylor College of Medicine/Texas Children's Hospital
    Bellaire, Texas, United States

    • Co-Author(s)

  • ER

    Elijah Roberts, N/A

    Medical Student
    Baylor College of Medicine, United States

  • FV

    Farrukh Virani, MD, MPH

    Assistant Professor
    Baylor College of Medicine/Texas Children's Hospital, United States

Disclosure(s):
Maheen Kara, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Differentiating between temporary and persistent dysphagia following a viral upper respiratory infection (URI) is challenging to do efficiently. This study evaluates the diagnostic utilization of early (≤4 weeks) versus delayed (>4 weeks) videofluoroscopic swallow study (VFSS) in pediatric patients.

Methods: A retrospective cohort study was conducted from 2023-2024 in children aged < 3 years who were admitted to a tertiary care pediatric hospital for an acute viral URI and received a VFSS. Chart review was done to collect data on demographics, virus type, and longitudinal VFSS outcomes. Patients were risk stratified into low and high-risk categories based on medical and anatomical comorbidities. The prevalence of acute versus persistent dysphagia (>3 months) across risk groups was analyzed with Chi-square tests.

Results: Among 81 children included in final analysis, early testing (n=25) resulted in an 88% dysphagia rate compared to 53.6% for delayed testing (n=56) (p < 0.01), suggesting transient inflammatory changes and incomplete recovery in the post-viral period rather than long-term dysfunction. Among high-risk children (n=69), dysphagia was identified in 87.5% of early studies compared to 66.7% of delayed studies. This analysis was likely underpowered and is not statistically significant (p=0.085). The strongest predictor of persistent dysphagia was bronchopulmonary dysplasia (BPD) (n=15; 93.3%), followed by Trisomy 21 (n=12; 75%) and neurodevelopmental delay (n=63; 73%). Conversely, 91.7% of normally developing children (n=12) passed their initial early VFSS (p < 0.001). Pathogen specific analysis showed that RSV had the highest prevalence of dysphagia (70%), followed by rhinovirus (67%).

Conclusions: Testing performed early in the immediate post-viral recovery course resulted in a high prevalence of dysphagia, but significantly fewer patients demonstrated deficits on repeat testing. Deferring VFSS for at least 4 weeks would allow for transient dysfunction to resolve and thus, reduce unnecessary radiation exposure, the time-cost burden of repeat testing, and intensive feeding therapy.