Single Topic Symposium
Pediatric Aerodigestive Medicine: Advancing Collaborative Care
Sunday, December 12

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

Session 1
10:00 AM - 10:10 AM Welcome
10:00 AM Welcome
    Hayat Mousa, MD, Children's Hospital of Philadelphia
10:05 AM Current state of Aerodigestive centers from the Pediatric GI Perspective
    José Cocjin, MD, Children's Mercy Hospital

Session 2
10:10 AM - 11:05 AM Triple Scopes and Evaluation from a Multidisciplinary Perspective
Moderator: Benjamin Gold, MD, FAAP, FACG, GI Care for Kids, LLC, Children's Center for Digestive Healthcare and Ramy Sabe, MD, University Hospitals
10:10 AM Airway endoscopy: an airway surgeons perspective
    Steven E. Sobol, MD, MSc, FRCS(C), FAAP, Children’s Hospital of Philadelphia
    Learning Objectives:
    • Differentiate between flexible and rigid airway endoscopy
    • Delineate role for triple endoscopy
    • Discuss strategies for interventional airway endoscopy
10:20 AM Pulmonary
    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
10:30 AM AIRWAY IMPEDANCE: A NOVEL DIAGNOSTIC TOOL TO EVALUATE EXTRAESOPHAGEAL SYMTOMS IN AERODIGESTIVE PATIENTS
    Rachel Rosen, MD, Boston Children's Hospital
10:35 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.
10:45 AM Mythbuster: VitalStim
    Jennifer Maybee, MA, CCC-SLP, Children's Hospital Colorado
10:50 AM Q&A

Session 3
11:05 AM - 11:35 PM Interactive Concurrent Sessions 

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, Lauren Jalali, MS, RD, LDN, Boston Children's Hospital and Wendelin A. Burdo-Hartman, MD, University of Illinois College of Medicine Peoria Children’s Hospital of Illinois 
    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

11:35 AM - 1:00 PM Break

Session 4
1:00 PM - 2:05 PM Therapeutic Multidisciplinary Approach to Oropharyngeal Conditions
Moderator: Amornluck Krasaelap, MD, Children's Mercy Hospital and Daniel Duncan, MD, Boston Children's Hospital
1:00 PM Multidisciplinary Management of Oropharyngeal Conditions: With a focus on clefts and a commentary on Laryngomalacia
    Steven E. Sobol, MD, MSc, FRCS(C), FAAP, Children’s Hospital of Philadelphia
    Learning Objectives:
    • Understand the diagnostic evaluation of surgical dysphagia patients
    • Know the types of laryngotracheoesophageal clefts
    • Understand the limitations of surgery for type 1 clefts
1:10 PM Airway malacia and Aspiration Lung injury
    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
1:20 PM To Thicken or Not To Thicken
    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
1:30 PM STABILITY OF ENFAMIL AR POWDER FORMULA OVER TIME AS A THICKENING TREATMENT FOR DYSPHAGIA
    Nina R Williams, MS, CF-SLP, Boston Children's Hospital
1:35 PM Feeding/Swallowing Evaluations and Feeding Management Strategies
    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
1:45 PM 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
1:55 PM Q&A

Session 5
2:05 PM - 3:00 PM Pathophysiology and Therapeutic Considerations in Complex Diseases from the Aerodigestive Perspective
Moderator: Christophe Faure, MD, Hospital Sainte Justine and Vrinda Bhardwaj, MD, Children's Hospital Los Angeles
2:05 PM Esophageal Atresia (EA)
    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
2:15 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
2:25 PM Tracheomalacia – Surgical management options
    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
2:35 PM Mythbuster: Lip and tongue tie
    Kara Larson, MS, CCC-SLP, Boston Children's Hospital
2:40 PM Q&A

3:00 PM - 3:10 PM Break

Session 6
3:10 PM - 3:45 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 and Eric Chiou, MD, Texas Children's Hospital
3:10 PM Sleep Medicine in Aerodigestive Conditions
    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
3:20 PM Non Invasive ventilation and tracheostomy in Aerodigestive disorders: How they affect feeding and symptoms?
    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?
3:30 PM Mythbuster: Chiari I malformation
    Vrinda Bhardwaj, MD, Children's Hospital Los Angeles
3:35 PM Q&A 

Session 7
3:45 PM - 4:30 PM Novel technologies in the diagnosis of Aerodigestive disorders
Moderator: Melanie Greifer, MD, New York University Medical Center and Diana Lerner, MD, Medical College of Wisconsin
3:45 PM Aerodigestive and ENT – What’s New
    Michael Rutter, MD, Cincinnati Children's 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
3:55 PM Novel Techniques in Pulmonary Aerodigestive Medicine
     Erik Hysinger, MD, MS, Cincinnati Children's Hospital 
    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
4:05 PM New Technologies: The Gastroenterologist’s Perspective
    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
4:15 PM Reflections
    Hayat Mousa, MD, Children's Hospital of Philadelphia