Feeding assessment and paediatric dysphagia — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar in a general paediatric clinic. A six-year-old with severe cerebral palsy is reviewed for faltering growth and three admissions with pneumonia over the past year. Her parents describe mealtimes lasting over an hour, food refusal and drooling, but no coughing or choking. Her weight has fallen from the twenty-fifth to below the third centile. A bedside feed observed by the speech-language therapist appears quiet and cough-free. The team asks you to interpret the bedside finding, to decide whether aspiration is excluded, to choose and justify an instrumental test, to grade her feeding ability, and to outline the management. You have twelve minutes with the team and five minutes for examiner discussion. ^[7]