Modified Barium Swallow (Cookie Swallow)

A modified barium (BARE-ee-um) swallow, or cookie swallow, is an X-ray test that takes pictures of your child’s mouth and throat while he or she swallows various foods and liquids.

• X-ray pictures are taken while your child eats and drinks foods and liquids brought from home that are mixed with a special liquid called barium.
• A modified barium swallow shows doctors if food or liquids are entering your child’s trachea (TRAKE-ee-uh) or windpipe during swallowing.
• A modified barium swallow gives doctors detailed information about the safety of your child’s swallowing that they cannot learn from a physical examination

There are several reasons why this test may be prescribed, including:

• Coughing and/or choking when eating or drinking
• A wet sounding voice
• Changes in breathing when eating or drinking
• Frequent respiratory infections.

These problems may be caused by food or liquid going into the airway after being swallowed.

• Your child should not eat or drink anything for 3 hours before the test.
• Because your child will be evaluated on how he or she swallows different foods and drinks, it is recommended that you bring with you: 
  • Small amounts of the foods and drinks that your child willingly accepts and swallows well;
  • Small amounts of the foods and drinks that your child has trouble swallowing; and
  • Any special feeding items normally used by your child (such as sippy cups, spoons, bottles, nipples).
• You may bring a “comfort” item–such as a favorite stuffed animal or “blankie”–for your child to hold during the test.

The modified barium swallow is done at the Department of Pediatric Radiology of UPMC Children’s Hospital. You will begin the appointment by meeting with a speech/language specialist, who is specially trained in swallowing disorders, to discuss your concerns about your child’s swallowing problems and answer any questions you may have about the test. The modified barium swallow will be done in a fluoroscopy (floor-OS-co-pee) room with:

• The speech/language specialist
• A pediatric radiology doctor who will be taking the X-ray pictures of your child’s throat
• An X-ray technologist who will be helping the doctor

In the room, you will see an X-ray machine, a television screen and a special chair. You might explain to your child that the X-ray machine is a large camera for taking pictures that will be shown on the television.

• Your child will be awake during this test.
• Your child will be asked to sit up in the chair just as he or she would eat at home.
• A seat belt will be placed over your child’s waist in the chair but your child will not be restrained.
• The speech/language specialist will mix the foods and liquids that are brought from home with a milky material called barium that will make the foods and drinks show up on the X-ray as your child is swallowing. You may want to explain to your child that the barium will change the taste and appearance of the foods and liquids.
• As your child eats and drinks the foods and liquids mixed with barium, the doctor will move the X-ray camera next to your child. The camera will come close to, but not touch, your child.
• The speech/language specialist may try to help your child swallow better by using different cups or bottles that have been brought from home, as well as straws and syringes.
• The speech/language specialist may also try thickening bottle feedings, typically by using barium mixed with either pudding or rice cereal.
• When the X-rays are complete, the speech/language specialist will meet with you in a consultation area to discuss the results of the exam. Recommendations to improve the way your child swallows will be given to you at this time.

As a parent, you may have concerns about radiation exposure. UPMC Children’s takes every precaution to make sure your child is safe.

• Our goal is to do the test correctly and thoroughly, while exposing your child to the smallest amount of radiation necessary to take the X-rays.
• Advances in equipment and film have lowered the amount of radiation your child will receive.
• All of the equipment is inspected regularly.
• Parts of the body that are not being X-rayed will be protected with a lead cover or apron when possible.

We welcome your help and support during this test. Parents or guardians are invited to join your child in the X-ray room. Other children can wait in the waiting room, or the Lemieux Sibling Center if siblings are ages 3 to 12 who are toilet trained.  We also welcome your child’s community feeding therapists (such as a speech pathologist or an occupational therapist) to come to the appointment to share information and to hear the results of the test.

• This test involves the use of radiation. Women who are pregnant or believe they may be pregnant should limit exposure to X-rays. In this case, please bring another adult who can stay with your child during the test.

The speech/language specialist will show you where to stand in the examination room and will guide you during the test. Please follow the instructions of the medical staff performing the modified barium swallow test.

• The speech/language specialist you met for the interview at the beginning of your child’s appointment will be with you throughout the entire appointment.
• The most important role of a parent or guardian during the test is to help your child stay calm and relaxed.
• The best way to help your child stay calm is for you to stay calm.
• Your job during the test will be either to feed your child foods and drinks or to encourage your child to feed himself or herself.
• We encourage you to talk to your child during the test and to be positive about the different foods and drinks mixed with barium in order to help your child be willing to try them.

The swallow study itself takes about 15 minutes. After the study, you will meet with the speech/language specialist to discuss the results of the test and answer any questions you may have. You may be given recommendations to help improve the way your child eats and drinks, as well as for follow-up appointments.

• Your child’s bowel movements will look white for a day or two because of the barium. White bowel movements are normal.
• After the test, your child can return to normal activities.
• The radiologist will send a report of your child’s swallow test to the doctor who prescribed it, usually within 48 hours. If the results are urgent, the referring doctor will be contacted immediately. The speech-language specialist will also send a separate report.
• If you have other questions or concerns about the test, please call the Department of Pediatric Radiology and a nurse or X-ray technologist will discuss them with you.

If your child has any special needs or health issues you feel the doctor needs to know about, please call the Department of Pediatric Radiology at UPMC Children’s before the test. It is important to notify us in advance about any special needs.

Before you come to the hospital, explain to your child what will happen in words that he or she can understand. Preparing your child beforehand, as well as comforting your child during the test, will help your child have a more positive experience. Sometimes it is difficult to know how to explain tests to children. If you have any questions about ways to prepare or support your child, or you feel your child will have difficulty during the test, please call the Department of Pediatric Radiology at Children's and ask to speak with the Child Life Specialist.

• Getting a Modified Barium Swallow (Cookie Swallow) (PDF)
• Getting a Modified Barium Swallow (Cookie Swallow) - Spanish (PDF)
• Getting a Modified Barium Swallow (Cookie Swallow) - Arabic (PDF)