Functional oral intake scale in toddlers: how much does it correlate with swallowing severity? An observational cross sectional study

  • Sally Mohamed Adel Faculty of Medicine-Alexandria University
  • Alaa H. Gaafar
  • Nader Fasseeh
  • Rania M. Abdou
  • Nesrine Hazem Hamouda
Keywords: Functional oral intake scale, swallowing, toddler


Background: The Functional Oral Intake Scale (FOIS) is a seven-point observer-reliable, valid rating scale that can be used without adding to the patient's workload. It was designed for stroke patients but is now used by adults and children. For newborns, a special scale was created. Toddlers are the transition from infant to adult swallowing. So the current study's goal is to assess the screening accuracy of the FOIS as an objective indicator of dysphagia in toddlers.

Methods: A cross sectional study of 123 toddlers attending dysphagia clinic with swallowing assessment of these patients. Another 123 healthy toddlers were assessed by FOIS as control. Two experienced clinicians scored the toddlers twice. VFSS was performed to assess swallowing of these patients.

Results: both Intra rater and inter-rater reliability were high with ICC= 0.984* and 0.946* respectively. Chi-square test showed a statistically significant difference of FOIS scores between cases and control group. There was a strong negative correlation between FOIS and PAS score in fluids with Pearson correlation coefficient (r=0.293 at p<0.001 while for semisolids and solids equally (r=0.424) while no correlation between FOIS score and total residue score. The cut off point for detection of aspiration at ≤5 using FOIS had high sensitivity 71.1 % in predicting aspiration of fluids with 43.6% specificity (AUC=0.617), with semisolids and solids 42.1 PPV and 72.3 NPV, (AUC= 0.754) with higher sensitivity than fluids (84.6%) and lower specificity (40.9 %). On the other hand, FOIS was very poor in predicting pharyngeal residue. It was highly sensitive in detecting the oral phase dysphagia 91.3 but low specificity 19.5, (AUC = 0.715*) (95% CI of 0.618-0.812).

Conclusion: FOIS has high screening power of oropharyngeal dysphagia in toddlers, with high prediction of fluids and semisolids aspiration but not pharyngeal residue. It was also highly predictive of oral phase dysphagia.