Side-Lying Position Is Associated With Improved Swallow Outcomes When Compared to Semi-Upright Position in Infants With Dysphagia

Abstract

Purpose: The purpose of this study was to examine the effects of side-lying and semi-upright positions on videofluoroscopic swallow study (VFSS) outcomes in infants with dysphagia. Method: A cross-sectional, within-subject design was employed. Infants diagnosed with dysphagia and undergoing VFSS as part of standard of care were prospectively identified at a tertiary care academic children's hospital. Both semi-upright and side-lying positions were assessed with thin liquids using identical bottles/nipples across positions. Severity and frequency of penetration/aspiration and pharyngeal swallow timeliness were rated by three speech-language pathologists specialized in the evaluation and management of pediatric dysphagia. Severity of airway invasion was assessed using the Penetration-Aspiration Scale (PAS) and swallow timeliness using a 3-point ordinal scale. Mixed-level modeling was used to compare swallow outcomes across positions to determine if side-lying was associated with decreased severity and frequency of airway invasion and timelier pharyngeal swallow initiation. Results: Twenty-one infants diagnosed with oropharyngeal dysphagia were included (Mage = 4.3 months, SD = 2.2). Side-lying position was associated with a significant decrease in severity and frequency of penetration/aspiration when compared with semi-upright position (p < .001). Side-lying position was associated with a 91% decrease in the odds of presenting with a more severe PAS rating when compared with semi-upright position (odds ratio = .09, 95% confidence interval = [.03, .21]). Improvements in airway protection in side-lying position were most common in infants with deep penetration/aspiration in semi-upright position. Significantly fewer pharyngeal swallows were initiated at the level of the pyriform sinuses in side-lying position when compared with semi-upright position (p < .001); however, the lowest level of swallow initiation was similar across positions. Conclusions: Side-lying position in infants with dysphagia was associated with less severe and less frequent penetration/aspiration when compared with semi-upright position. Future research should identify predictors of which infants benefit most from side-lying position, as well as the physiological mechanisms underlying these findings.