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When to Refer for FEES: A Clinical Quick Reference

A timely FEES referral can change a resident's trajectory — preventing pneumonia, identifying the safest diet, and accelerating treatment. Use this quick reference to decide when an instrumental swallow evaluation is warranted.

Mealtime signs

These are the most visible cues during meals and feeding — observable by nursing staff, CNAs, and family members, not just SLPs.

  • Coughing during meals
  • Wet vocal quality
  • Frequent choking episodes

Relevant medical history

Conditions that compromise swallow function, alertness, or airway protection often warrant a FEES even before mealtime signs appear.

  • Recent stroke
  • Neurodegenerative disease (Parkinson's, ALS, MS, dementia)
  • Traumatic brain injury

Clinical indicators

These are the higher-stakes signals — usually flagged by the interdisciplinary team during clinical review.

  • Recurrent pneumonia
  • Unexplained weight loss
  • Suspected aspiration
  • Difficulty managing secretions
  • Significant changes in swallowing function
  • Need for objective assessment prior to diet changes

TIME-SENSITIVE

If a resident is showing acute decline, pneumonia, or rapidly worsening swallow function, call us at 562-645-FEES (3337) to expedite scheduling.

Have questions about this guide?

Call 562-645-FEES (3337) or email info@camobilefees.com — Jerra and team respond personally.