Multidisciplinary Approach to Complex Breathing and Swallowing Disorders in Children

By James Scott McMurray, MD

The American Family Children’s Hospital and the Departments of Surgery and Pediatrics are excited to announce the start of a new pediatric multidisciplinary team that will assess and treat complex children with disorders of breathing and swallowing.


The UW Health Pediatric Aerodigestive Clinic Team (PACT) is a family centered multi-specialty group of experts, focused on the assessment and treatment of chronically ill children with complex airway, pulmonary, upper digestive tract, sleep, feeding and voice disorders. The team of Pediatric Specialists include Pediatric Otolaryngology, Speech and Language Pathology, Pulmonology, Gastroenterology, Anesthesiology, Sleep Medicine, Radiology, Cardiothoracic Surgery, General Surgery, Genetics, and Pediatric Intensive Care Specialists (PICU). The team will provide a comprehensive assessment of the child’s breathing, swallowing or voice problems in a holistic manner. A team meeting will allow for future coordinated care. Diagnostic studies and future operative endoscopies will be arranged together to decrease the number of visits and to minimize the total number of separate procedures, while still allowing for a complete and thorough evaluation.

A complete historical review for any pre-existing pulmonary and gastrointestinal disorders that may complicate or exacerbate the aerodigestive problem will be performed. Anatomical and functional problems of the aerodigestive tract will be assessed through office endoscopy. Voice and swallowing problems will also be evaluated with fiberoptic laryngoscopy, FEES(flexible endoscopic evaluation of swallow) and modified barium swallow.

If further operative diagnostic endoscopy or other tests are needed, these will be combined into a single procedure and anesthetic. Typical procedures that could be combined would be laryngoscopy, bronchoscopy, flexible bronchoscopy with bronchoalveolar lavage, esophagogastrodudenoscopy, esophageal biopsy, pH and manometry probe placement and adenotonsillectomy.

Once the evaluation phase has been completed, the team will reconvene and determine all the current pertinent medical conditions that need to be addressed to maximize the outcome. If a surgical procedure for airway reconstruction is contemplated, all medical conditions will be treated and maximized prior to the surgical intervention. This will place the child in the best state for a successful outcome.

Pediatric Specialists include:

  • Pediatric Otolaryngology
  • Speech and Language Pathology
  • Pulmonary Medicine
  • Gastroenterology
  • Cardiothoracic Surgery
  • General Surgery

Roadmap for the Evaluation

After referral to the UW PACT, the family will be contacted and interviewed so that all pertinent previous work up can be collated and reviewed. After review, a visit will be planned. The visit will be intensive over several consecutive days to decrease the number of visits required and increase the information that can be gathered.

Sleep studies may be performed on Monday night as an inpatient appointment or Tuesday night as an outpatient appointment. Modified barium swallows will be performed Tuesday morning. If there are other radiographs or pulmonary function tests, these will also be performed Tuesday. The family will come to clinic on Tuesday afternoon to been seen by Speech Pathology, Pediatric Otolaryngology, Pediatric Pulmonary and Pediatric Gastroenterology. Office flexible laryngoscopy and FEES can be performed to look at laryngeal and swallowing function.

Operative endoscopy will be performed on Wednesday in the AFCH OR. Drug induced sleep endoscopy, rigid laryngoscopy and bronchoscopy, flexible bronchoscopy with bronchoalveolar lavage, esophagogastroduodenoscopy with biopsy and placement of pH manometry can be performed. CT of the chest can be performed with anesthesia if necessary.

Once all the tests have been reviewed, a multidisciplinary assessment and recommendation will be communicated to the family and referring provider.

For more information

The UW Health Pediatric Aerodigestive Clinic Team or PACT focuses on treating children with complex airway, pulmonary, digestive tract, sleep, feeding and voice disorders. For questions about a patient or a referral, please contact one of our clinics.