Clinical feeding assessment: An effective screening test to predict aspiration in children in low resource settings.
Vijeyta Dahiya, Naina Picardo, Ramanadham Thejesh and 2 others
PMID 37807789WHAT IT FOUND
A clinical feeding assessment is a sensitive screening tool for aspiration in children.
A negative result reliably rules out aspiration, allowing clinicians to avoid invasive instrumental testing. However, a positive result has low specificity, meaning many children are falsely flagged and require further evaluation.
Key findings
01Clinical feeding assessment demonstrated high sensitivity (80-100%) and negative predictive value (96-100%) for detecting aspiration, making it effective for ruling out risk.
02The test showed low specificity (68.6-78.8%) and positive predictive value (26.7-34.7%), indicating a high rate of false positives where children were flagged for aspiration but did not have it on instrumental evaluation.
03History of nasal regurgitation and spasticity on examination were significant independent predictors of aspiration.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was conducted in a single tertiary center in a low-resource setting, which may limit generalizability to other clinical environments. The sample size was small (80 children), and the number of children with true aspiration on FEES was very low (10-26 per consistency), affecting the precision of the positive predictive value estimates. The CFA definition of positive aspiration relied on overt signs (cough, wet voice, distress), which may not capture silent aspiration, a known limitation of clinical assessment.
Declared interests
The authors declared no conflicts of interest, and the research received no specific funding from any agency.
The easy way to misread this
Do not assume a positive Clinical Feeding Assessment confirms aspiration. The high false-positive rate means that a child flagged by CFA may not actually be aspirating on instrumental evaluation, so this result alone should not dictate permanent changes to feeding protocols without further objective testing.