Preferred Name

Julian Bergen White

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.


Date of Graduation


Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Communication Sciences and Disorders


Cynthia O’Donoghue

Erin Kamarunas

Carol C. Dudding

Heather Bonilha


Speech-Language Pathologists (SLP) are the primary healthcare providers responsible for the evaluation and treatment of infant feeding and swallowing disorders. At-risk infants, such as those born prematurely or with certain medical conditions, are more prone to swallowing impairments (i.e., dysphagia). Dysphagia in at-risk infants can have severe consequences such as chronic respiratory symptoms, pneumonia, progressive lung disease, undernutrition, and death. Therefore, it is important to have methods of examining an infant’s swallow functioning that are both safe and accurate. A leading method of evaluating infant swallowing is the Modified Barium Swallow Study (MBS). The works contained within this dissertation document include three research studies conducted on topics related to speech-language pathology (SLP) practices in assessing and treating infants who are at-risk for swallowing and feeding disorders (i.e., dysphagia). Specifically, these three studies investigated aspects of best-practices for the Modified Barium Swallow Study.

The first study, entitled A Preliminary Investigation of the Effect of Fluoroscopic Rate on NICU Swallow Ratings and Recommendations, investigated how reducing fluoroscopic pulse rate, in an effort to reduce radiation dose, effects SLP assessment of swallow parameters and feeding recommendations for infants in the Neonatal Intensive Care Unit (NICU). Segments of previously recorded infant MBS were rated on five swallow parameters. The ratings were compared between MBS rated at 30 frames per second (fps) and at 15 fps. Reducing frame rate resulted in differences in some, but not all, swallow parameter ratings. Feeding recommendations were different between MBS rated at 30fps vs 15fps. The results of this first study support the continued use of 30 pulses per second during MBS conducted for infants in the NICU, although further investigation on a larger scale is warranted.

The second study explored SLP experiences and perceptions regarding the use of side-lying position during infant MBS. Entitled Speech-Language Pathologists’ Perspectives on Side-Lying Position to Improve Swallow Performance during MBS, this qualitative study aimed to contribute greater understanding of the current practices by SLPs in the use of side-lying position during infant MBS. Qualitative data was collected through six semi-structured interviews of hospital SLPs. Interviews were transcribed, coded via initial coding and a consensus coding approach, and analyzed to develop themes. Results of this study were that while SLPs acknowledge the importance of MBS replicating an infants’ typical feeding, some SLPs who consistently use side-lying position during feeding do not conduct MBS in side-lying position. This inconsistency in practice results from the SLPs’ perceived barriers, including lack of experience, concern for interdisciplinary conflict, need for MBS protocols, and lack of research investigating the impact of side-lying position on infant swallow function and safety. SLPs report the need for additional research that investigates whether side-lying position alters, possibly improving, airway protection during swallowing for at-risk infants.

The third study, The Influence of Side-lying Position on Oropharyngeal Swallow Function in At-risk Infants: An exploratory study, examined the effect of side-lying position on infant swallow physiology, including airway invasion, swallow initiation, and suck-swallow-breathe coordination. Infant MBS recordings were retrospectively examined in matched-pairs comparing nine at-risk infants swallowing with the same liquid consistency, bottle, and nipple in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Side-lying position reduced severity of airway invasion during the swallow for some, but not all, medically complex infants. Bolus location at the time of swallow initiation was overall higher, representing decreased risk of airway invasion, when at-risk infants were fed in side-lying position compared to cradled position. Infants fed in side-lying position demonstrated, on average, fewer swallows per breaths compared to when they are fed in cradled position. The results of this third study suggest that side-lying position should be considered as a viable strategy to improve swallow safety in at-risk infants who exhibit oropharyngeal dysphagia. Additional investigation with larger, randomized controlled methods would further inform the effect of side-lying position on infant swallow function.



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