Single Topic Symposium
Pediatric Aerodigestive Medicine: Advancing Collaborative Care
Wednesday, November 3, 2021

Co-Chairs: Hayat Mousa, MD and José Cocjin, MD

8:00 AM - 8:30 AM Welcome
Moderator: Hayat Mousa, MD, Children's Hospital of Philadelphia
8:00 AM Welcome
    Benjamin Gold, MD, FAAP, FACG, GI Care for Kids, LLC, Children's Center for Digestive Healthcare
    Welcome panel:
  • Joel Friedlander, DO, M.A., Bioethics, Children's Hospital Colorado
  • Hayat Mousa, MD, Children's Hospital of Philadelphia
  • Rachel Rosen, MD, Boston Children's Hospital
  • José Cocjin, MD, Children's Mercy Hospital
8:05 AM Current state of Aerodigestive centers from the Pediatric GI Perspective
    José Cocjin, MD, Children's Mercy Hospital
8:15 AM Cost and quality benefits to Aerodigestive centers
    Eric Chiou, MD, Baylor College of Medicine

8:30 AM - 9:30 AM The Role of the Gastroenterologist in Aerodigestive Symptomatology: How to approach these symptoms
Moderator: Sari Acra, MD, MPH, Vanderbilt University Medical Center
8:30 AM Esophageal Dysphagia
    Ajay Kaul, MBBS, MD, Cincinnati Children's Hospital
8:42 AM Vomiting
    Benjamin Gold, MD, FAAP, FACG, GI Care for Kids, LLC, Children's Center for Digestive Healthcare
8:54 AM Food aversion, tube dependency
    Scott Pentiuk, MD, Cincinnati Children's Hospital
9:06 AM Cough, recurrent croup
    Melanie Greifer, MD, New York University Medical Center
9:18 AM Panel Discussion

9:30 AM - 9:50 AM Break

9:50 AM - 10:45 AM Triple Scopes and Evaluation from a Multidisciplinary Perspective
Moderator: Joel Friedlander, DO, M.A., Bioethics, Children's Hospital Colorado
9:50 AM ENT
    Steven E. Sobol, MD, MSc, FRCS(C), FAAP, Children’s Hospital of Philadelphia
    Learning Objectives:
    • Discuss the most common ENT findings observed at triple endoscopy.
    • Review the lesions that are amenable to intervention, and/or surgically repairable
    • Understand the diagnostic modalities that can be employed by ENT in the OR during triple endoscopy
10:00 AM Pulmonology
    Emily DeBoer, MD, Children's Hospital Colorado
    Learning Objectives:
    • Appreciate the major pulmonary pathology observed at diagnostic bronchoscopy
    • Discuss the diagnostic tools that can be employed at bronchoscopy and the significance behind each
    • Review the key pulmonary features of concern for the dysphagic child, and, when bronchoscopy would be
        helpful
10:10 AM GI
    Dana Williams, MD, Phoenix Children's Hospital
    Learning Objectives:
    • Review the key visual and histological features of the major GI conditions found at diagnostic EGD during the
        triple scope
    • Discuss the frequency of eosinophilic esophagitis found at triple scope; comorbid conditions that are most
        common and the management approach
    • Appreciate the diagnostic modalities to assess esophageal, gastric and duodenal function at the time of triple
        endoscopy and when optimally employed.
10:20 AM Panel discussion

10:45 AM - 11:00 AM Hot Topic
Toxins in cereal and baby food: Implications for thickening and the aerodigestive practice
    Julie Khlevner, MD, Columbia University Vagelos College of Physicians and Surgeons
    Learning objectives:
    • Review the current knowledge and clinical implications for thickening practices for pediatric patients with
        aerodigestive disorders
    • Discuss the types of available thickeners for pediatric practices
    • Understand the evidence behind toxin exposure in routinely used thickeners
 
11:00 AM - 11:20 AM Abstract Presentations

11:20 AM - 11:35 AM Rapid Fire Myth Busters

Moderator: Daniel Duncan, MD, Boston Children's Hospital
11:20 AM VitalStim
    Jennifer Maybee, MA, CCC-SLP, Children's Hospital Colorado
    Learning objectives:
    • Learners will gain a basic understanding of what Vital Stim is and the theory underlying it
    • Understanding of the global research findings to date regarding use of Vital Stim in children
11:25 AM Chiari I malformation
    Vrinda Bhardwaj, MD, Children's Hospital Los Angeles
11:30 AM Lip and tongue tie
    Kara Larson, MS, CCC-SLP, Boston Children's Hospital
11:35 AM - 1:00 PM Concurrent Lunch Sessions **Please note Lunch Sessions will not be recorded and available as part of the On-Demand service

1. Medical and psychological interventions for functional aerodigestive disorders: Rumination, vocal cord dysfunction, habitual cough
Anil Darbari, MD, MBA, Children's National Medical Center and Jennifer Verrill Schurman, PhD, ABPP, Children's Mercy Hospital
    Learning Objectives:
    • Review the clinical presentation and diagnostic approach for rumination syndrome, vocal cord
        dysfunction/paradoxical vocal fold movement, and habit cough
    • Review the patient populations affected by functional aerodigestive disorders
    • Understand the types of treatments available and the medical and psychological interventions used to treat
        functional aerodigestive disorders
    • Identify the appropriate referral location for each functional aerodigestive disorder

2. Nuances of thickening:/blenderized diet: Tips from GI, Nutrition and SLP
Jennifer Maybee, MA, CCC-SLP, Children's Hospital Colorado, Daniel Duncan, MD, Boston Children's Hospital and Wendelin A. Burdo-Hartman, MD, Nationwide Children's, 
    Learning Objectives:
    • Identify the available forms of thickener (pharmacologic and food based) used in feeding interventions
    • Review different levels of thickening liquids, including National Dysphagia Diet (NDD) versus International
        Dysphagia Diet Standardization Initiative (IDDSI) standards
    • Understand the variations between commercial and home-made blenderized diets
    • Review the benefits versus risks associated with using thickened liquids or blenderized diets in the
        aerodigestive population

3. Quality metrics for Aerodigestive programs: What metrics to consider, how to collect them and how to assess for improvement
Maireade McSweeney, MD,MPH, Boston Children's Hospital, Eric Chiou, MD, Baylor College of Medicine and Joel Friedlander, DO, M.A.-Bioethics, Children's Hospital Colorado
    Learning Objectives:
    • Review the key factors which define the quality of multidisciplinary aerodigestive care
    • Identify the various forms of data collection that can be applied to an aerodigestive program, including process
        versus patient-centered outcomes
    • Review the benefits of utilizing efficiency metrics, safety metrics, patient population metrics, and operative
        metrics in an aerodigestive program
    • Discuss the challenges and future directions for quality improvement in aerodigestive medicine

4. Nasal endoscopy: Transnasal endoscopy and FEES for bedside diagnoses
Matthew Ryan, MD, Children's Hospital of Philadelphia, Matthew Brigger, MD, MPH, UCSD Rady Children's Hospital and Kimberly Morris, MS, CCC-SLP, BCS-S, IBCLC, Rady Children's Hospital
    Learning Objectives:
    • Review the indications for nasal endoscopy
    • Review the techniques for success even in young children
    • Discuss the key features to building a TNE and FEES program
1:00 PM - 2:00 PM Therapeutic Multidisciplinary Approach to Oropharyngeal Conditions
Moderator: Amornluck Krasaelap, MD, Children's Mercy Hospital
1:00 PM GI & ENT
    Kristin Fiorino, MD Children’s Hospital of Philadelphia and Steven E. Sobol, MD, MSc, FRCS(C), FAAP, Children’s Hospital of Philadelphia
    Learning Objectives:
    • Review the different types of laryngeal clefts and options for surgical intervention
    • Assess the red flags for laryngomalacia and know when to refer or intervene
    • Identify tongue ties and understand the role they play in feeding
1:12 PM Pulmonology
    R Paul Boesch, DO, Mayo Clinic
    Learning Objectives:
    • Recognize the types of malacia and degree of impairment at various levels of the airway
    • Understand the management of tracheomalacia
    • Appreciate the different modalities for assessing lung disease from chronic aspiration
1:24 PM GI
    Matthew Ryan, MD, Children's Hospital of Philadelphia
    Learning Objectives:
    • Review the available commercial thickeners for infants and children
    • Recognize the complications from thickening such as constipation, NEC risk, etc
    • Understand the role of formula additives for dysphagia, reflux or supplemental caloric intake
1:36 PM SLP/OT
    Jennifer Maybee, MA, CCC-SLP, Children's Hospital Colorado
    Learning Objectives:
    • Identify when to refer for clinical speech evaluation, FEES or video fluoroscopic swallow study
    • Discuss the benefits of thickening feeds, changing feeding strategies or NG feeds in infants
1:48 PM Panel Discussion

2:00 PM - 2:15 PM IDDSI testing demo
2:15 PM - 3:15 PM Pathophysiology and Therapeutic Considerations in Complex Diseases from the Aerodigestive Perspective
Moderator: Christophe Faure, MD, Hospital Sainte Justine
2:15 PM TEF, EA, VATER
    Diana Greyz Lerner, MD, Medical College of Wisconsin
    Learning Objectives:
    • Discuss evaluation and management of esophageal stricture after TEF/EA repair
    • Discuss evaluation and management of recurrent TEF
    • Discuss risk of GERD/EOE in children after TEF/EA repair
2:27 PM Post-op anatomy/pullup/hernia- GI to the rescue
    Joel Friedlander, DO, M.A.-Bioethics, Children's Hospital Colorado
    Learning Objectives:
    • Discuss complications after gastric pull up, colonic interposition, jejunal interposition and GI role in
        management of a child after esophagectomy including food stasis, fungal overgrowth, esophagitis,
        and need for re-operation
2:39 PM Vascular ring
    Ram Kumar Subramanyan, MD, PhD, Children's Hospital Los Angeles
    Learning Objectives:
    • Review the diagnostic approach of vascular rings
    • Discuss risk/benefits of surgical interventions for vascular ring
2:51 PM Tracheobronchomalacia and surgery
    Daniel von Allmen, MD, Cincinnati Children's Hospital
    Learning Objectives:
    • Natural history of Tracheobronchomalacia
    • Review the diagnostic approach of Tracheobronchomalacia
    • Discuss the benefits of surgery for Tracheobronchomalacia
3:03 PM Panel Discussion

3:15 PM - 3:35 PM Break
3:35 PM - 4:05 PM Sleep disorders and their interactions with aerodigestive conditions: CPAP, BiPAP, trachs and how they affect feeding and symptoms
Moderator: Hayat Mousa, MD, Children's Hospital of Philadelphia
3:35 PM Sleep Physician
    Baha Al-Shawwa, MD, FCCP, Children’s Mercy Kansas City
    Learning Objectives:
    • Definitions of NIV techniques (CPAP, BiPAP, High flow nasal canula, etc…)
    • Indications in aerodigestive conditions
    • Basic management of NVI in aerodigestive conditions
3:47 PM GI Physician
    Christophe Faure, MD, Hospital Sainte Justine
    Learning Objectives:
    • GI side effects of NVI techniques and tracheostomy (aerophagia, dry mouth, modifications of swallowing
        dynamics, …)
    • Feeding disorders associated with NVI
    • How to address the problems?
3:59 PM Q&A Panel
4:05 PM - 4:45 PM Novel technologies in the diagnosis of Aerodigestive disorders
Moderator: Melanie Greifer, MD, New York University Medical Center
4:05 PM ENT
    Michael Rutter, MD, Cincinnati Childrens Hospital
    Learning Objectives:
    • Review new and emerging technologies such as 3D imaging in diagnosis of Aerodigestive disorders
    • Present new and emerging therapeutic techniques in aerodigestive patients
4:17 PM Pulmonology
    Joseph Piccione, MD, Children's Hospital of Philadelphia 
    Learning Objectives:
    • Review new and emerging technologies in diagnosis of aerodigestive disorders including CT/MR imaging of
        the lungs
    • Present new and emerging therapeutic techniques such as cryotherapy in aerodigestive patients
4:29 PM GI
    Rachel Rosen, MD, Boston Children's Hospital
    Learning Objectives:
    • Review the use of transnasal endoscopy in the diagnosis of aerodigestive disorders
    • Present the use of the various new impedance modalities EsoFlip and EndoFLIP in use of diagnosis and
        therapeutic interventions
    • Discuss new and emerging techniques of evaluation of gastric disorders including HREGG (high resolution
        electrogastrogram) and Gastric FLIP
4:41 PM Q&A Panel
4:45 PM - 5:00 PM The Future of Aero Panel Discussion
Rapid Fire Topics
    • The Medical Home
    • Interfacing with general and complex care pediatricians
    • Value based care
    • Seamless communication between inpatient and outpatient settings
    • Multicenter collaboration to improve outcomes
Panel:
    Hayat Mousa, MD, Children's Hospital of Philadelphia
    Rachel Rosen, MD, Boston Children's Hospital
    Joel Friedlander, DO, M.A.-Bioethics, Children's Hospital Colorado
    José Cocjin, MD, Children's Mercy Hospital

5:00 PM - 5:15 PM Conclusions
Hayat Mousa, MD, Children's Hospital of Philadelphia and Benjamin Gold, MD, FAAP, FACG, GI Care for Kids, LLC, Children's Center for Digestive Healthcare