Characterizing Puree Bite Sizes in People with Normal and Disordered Swallowing: Predictors and Impact on Swallowing Safety and Efficiency during Flexible Endoscopic Evaluation of Swallowing.
James A Curtis, Kate Kocins, Anaïs Rameau and 2 others
PMID 41100424WHAT IT FOUND
Self-selected puree bites were typically 10.3 mL overall and 11.1 mL in natural conditions.
FEES bites with blue-colored pudding, transnasal endoscopy, and single-swallow instruction were 2.4 mL smaller. Swallow impairment did not predict bite size. Larger bites increased residue most in severe or profound impairment.
Key findings
01Median self-selected puree bite size was 10.3 mL across 343 trials and 11.1 mL across 196 most natural trials.
02FEES bites with blue-colored pudding, transnasal endoscopy, and single-swallow instruction were 2.4 mL smaller, a 20% decrease from 11.4 mL to 9.0 mL.
03Neither patient-perceived swallowing difficulty nor clinician-rated swallowing impairment predicted self-selected puree bite size.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
One spoon size was used, and smaller spoons can produce smaller bites, so natural bite sizes may be underestimated. Most participants had no or mild to moderate impairment, so results may not apply to severe or profound dysphagia. Multiple-comparison correction may have hidden effects; height and weight were associated with bite size before correction. Medical diagnosis, oral status, and social or environmental factors were not analyzed. Pre-FEES trials did not require swallowing, which may have influenced chosen bite sizes.
The easy way to misread this
Do not assume that a self-selected bite during FEES shows how the patient eats at home. FEES bites with blue-colored pudding, transnasal endoscopy, and single-swallow instruction were 2.4 mL smaller, a 20% decrease from natural bites.
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