Implementation, Indications, and Rationale for Modified Free Water Protocols in Paediatric Dysphagia: A UK Survey

Implementation, Indications, and Rationale for Modified Free Water Protocols in Paediatric Dysphagia: A UK Survey | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Implementation, Indications, and Rationale for Modified Free Water Protocols in Paediatric Dysphagia: A UK Survey Alanna Thompson , Jessica De Bolfo doi: https://doi.org/10.1101/2025.11.18.25340471 Alanna Thompson 1 Highly Specialised Speech and Language Therapist, St George’s Hospital , London MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: alanna.thompson{at}stgeorges.nhs.uk Jessica De Bolfo 2 Clinical Lead SLT (Acute Paediatrics), St George’s Hospital , London MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Modified Free Water Protocols (MFWPs) are increasingly referenced in UK paediatric dysphagia practice despite no published paediatric evidence of safety or efficacy. Aims To examine how, for whom, and why MFWPs are used or discussed by UK Speech and Language Therapists (SLTs), whether clinicians can reference any supporting evidence, and how outcomes are monitored. Methods Cross-sectional online survey of UK paediatric dysphagia SLTs with Likert-scale, yes/no, and open-ended items; data analysed descriptively and thematically. Results Sixty-eight clinicians responded; 64 % (44/68) reported using an MFWP, yet only 12 % (8/68) had local written guidance. Most adaptations derived from adult FWPs, most often the Frazier protocol. No respondent cited paediatric evidence or justification for “cooled-boiled/’sterile’” water. MFWPs were applied to children with thin-fluid aspiration, refusal of thickeners, chronic respiratory disease, and severe neurological impairment; groups that would not meet adult FWP candidacy. Outcome monitoring centred on respiratory health but without details of how or when monitoring occurred; hydration and functional indices were rarely reported. Conclusions UK clinicians are applying heterogeneous, unvalidated adaptations of adult FWPs to children. The use of “cooled-boiled/ “sterile’” water is unsupported and distracts from evidence-based safeguards such as oral care and supervision. National guidance and paediatric outcome evidence are urgently required. Introduction Aspiration of thin fluids (IDDSI Level 0) in children with dysphagia is clinically significant and associated with pneumonia, dehydration, and reduced quality of life. 1 – 3 Silent aspiration is common and often undetected without instrumental assessment; therefore, video-fluoroscopic swallow study (VFSS) or flexible endoscopic evaluation of swallowing (FEES) are essential for accurate diagnosis and management. 4 - 6 . Thickened fluids are frequently recommended to reduce aspiration risk, yet they may negatively affect hydration, enjoyment, and compliance. 7 – 10 Clinicians therefore face complex trade-offs between airway protection and quality of life, particularly when children refuse thickeners or have limited access to instrumental assessment. In adult rehabilitation, Free Water Protocols (FWPs) notably the Frazier Free Water Protocol 11 and GF Strong Water Protocol 15 permit carefully selected patients access to water under strict safeguards: medical stability, adequate cognition, absence of active pneumonia, meticulous oral hygiene, water only between meals, supervision, and medication precautions. In adults, when applied to appropriate candidates, pneumonia incidence does not increase. 12 – 14 , 16 , 17 Importantly, adult FWPs presume potable water and do not require “cooled-boiled” or “sterile” water. Within paediatric practice, references to so-called Modified Free Water Protocols (MFWPs) have emerged, yet no paediatric data confirm their safety or efficacy. Reported approaches often mirror adult FWPs but incorporate untested modifications, most notably the recommendation for “cooled-boiled” or “sterile” water. This survey was intended to examine how, for whom, and why MFWPs are implemented in UK paediatric practice; to determine whether clinicians possess or can reference any evidence supporting the paediatric use of MFWPs, including the “cooled-boiled/’sterile’” modification; and to describe how outcomes are monitored. Caveat regarding the term “protocol” Although the phrase “modified free water protocol” (MFWP) is commonly used in UK paediatric dysphagia practice, it does not accurately reflect a validated, standardised, or evidence-based protocol. The term “protocol” implies a formally developed and consistently applied intervention with defined eligibility criteria, safeguards, implementation procedures, and outcome measures, which is not yet established for paediatric populations. Nevertheless, for the purposes of reporting and interpreting survey findings, the term “MFWP” will be used in this paper to reflect the colloquial terminology currently used by clinicians to describe the practice of allowing children with known or suspected aspiration of fluids to consume water orally under specified conditions or restrictions. Findings however challenge the appropriateness of this terminology and highlight the need for more accurate, specific language. Methods Design and Participants A descriptive, cross-sectional online survey was distributed between [insert months/year] to UK-based HCPC-registered SLTs managing paediatric dysphagia. Recruitment used national and regional networks (Paediatric Clinical Excellence Network, acute paediatric SLT groups). Participation was voluntary and anonymous. Survey Instrument The questionnaire comprised Likert-scale, yes/no, and open-ended items exploring: demographics and setting; MFWP use vs non-use; confidence and perceived evidence; patient selection and contraindications; implementation details (timing, oral care, supervision, and recommendations regarding “cooled-boiled/’sterile’” water); protocol origin and modification (adult FWPs cited); outcome monitoring and service integration; and an explicit request for citations supporting paediatric MFWPs or specific modifications. Five senior SLTs reviewed the draft for clarity and face validity. Data Analysis Only responses from UK-based clinicians were analysed to ensure contextual comparability and consistency with national policy frameworks. The survey incidentally reached a small number of international respondents (n = 11; Australia n = 6, New Zealand n = 5), whose data were excluded from analysis to preserve focus and interpretive validity. Quantitative items were summarised as frequencies and percentages using Microsoft Excel 365. Qualitative responses underwent inductive thematic analysis by both authors to identify patterns in how, for whom, and why MFWPs were used. Keyword searches tallied adult protocols named (“Frazier”, “GF Strong”), references to “boiled/cooled/sterile”, and descriptions of outcome monitoring. Governance and Ethics St George’s Hospital Research & Information Governance confirmed that NHS Research Ethics Committee review was not required (service evaluation/professional practice study). No patient-identifiable data were collected. Results UK respondents n = 68 Geographical and Professional Profile Download figure Open in new tab Self-reported use, confidence levels, and guidance for MFWP use Download figure Open in new tab Adult Protocols and Modifications Most clinicians reported adapting an adult FWP, but did not specifically cite the adult FWP that they had modify. The Fraizer FWP 11 was cited 10 times. No other FWP was cited. Interestingly, although the FFWP emphasises oral hygiene, between-meals timing, supervision, and medication rules; it does not include a recommendation for “cooled-boiled/’sterile’” water. 11 – 17 . “Cooled-boiled/ “Sterile” Water Mentions of “boiled/cooled” appeared in at least 8 responses; “sterile” in 4. No participant cited supporting evidence for this. It should be noted that true sterility requires aseptic preparation, handling, and storage, and no respondant described sterile preperation, storage, and handling of “sterile” water. Additionally, no respondant provided information on how they instruct families to sterilise water, with many respondants referring to sterile and cooled boiled water interchangably. WHO and CDC guidance indicate that bringing water to a rolling boil for one minute inactivates pathogens where tap water is unsafe, 18 – 21 but in the UK drinking water is already regulated to microbiological standards. Boiling therefore provides no added protection against aspiration-related infection. The focus on “sterile” water risks diverting attention from the adult-FWP safeguard most relevant to pneumonia risk reduction, which is oral hygiene. Patient Selection and Contraindications Indications included refusal of thickeners (at least 34), thin-fluid aspiration (at least 24), respiratory disease (at least 13), severe neurological impairment (at least 2), and community/outpatient contexts (at least 1). Many such cases would not meet adult FWP eligibility criteria (medical stability, cognition, supervision, absence of active infection). 11 – 17 Conditions emphasised cognition (at least 11) and oral care (at least 4). Contraindications included active chest infection, respiratory compromise, overt cough, and severe neurological impairment. Timing and supervision were infrequently described. Outcome Monitoring Monitoring practices were highly variable and often vaguely described. Most respondents referred to “respiratory health” or “chest infections,” but none explained how or when these outcomes were monitored, whether via clinical review, caregiver report, or record audit. No consistent timeframe, metric, or cessation criterion was reported. Hydration indices (for example, fluid charts) were mentioned by at least four respondents and caregiver feedback by a similar number; growth monitoring was rarely mentioned. Discussion Collectively, findings show that MFWPs are being used in paediatric dysphagia practice despite no paediatric evidence. Clinicians appear motivated by hydration and quality-of-life concerns, particularly where thickeners are refused or instrumental assessment is delayed. Yet fundamental safeguards central to adult FWP, including oral hygiene, between-meals timing, supervision, and medication management were inconsistently reported, while unvalidated additions (notably “cooled-boiled “sterile’” water) have appeared without evidential rationale. The introduction of “cooled-boiled/’sterile’” water has no published origin and misuses the term sterile. WHO and CDC guidance on boiling water pertains to unsafe public water supplies, not aspiration prevention; UK tap water is already safe to drink. 18 – 21 Using the terms “cooled boiled” and “sterile” water interchangably is erroneous. True sterility requires sterile preperation, handling, and storage. Therefore, focus on water sterility is therefore moot in this context and potentially distracting. Aspiration pneumonia is primarily associated with oral bacterial load and biofilm, 22 – 24 supporting the adult-FWP focus on oral care as a risk-mitigation measure. Reported patient groups often included children with severe neurological or respiratory compromise individuals explicitly excluded from adult FWPs. Referring to such discretionary local practices as “protocols” risks conveying an illusion of validation and may mislead families and colleagues regarding the evidential status of these interventions. Although many clinicians stated that respiratory outcomes were monitored, none described how these were tracked, whether prospectively, by audit, or opportunistically during follow-up. The absence of defined frequency, metrics, or triggers for cessation underscores the lack of standardisation and precludes reliable evaluation of safety or efficacy. Limitations Interpretation should consider limitations. The sample was modest and self-selected; data were self-reported; free-text coding may under-represent themes. No patient outcomes were measured, so causation cannot be inferred. Despite these constraints, the consistency of themes across diverse regions and settings suggests a genuine, system-wide evidence gap. Future Directions Future research should avoid using the term “modified free water protocol” for children, as adult derived terminology and safeguards have not been validated in paediatric populations. Instead, studies should identify which child specific strategies, such as enhanced oral care, supervised access to water, timing relative to meals, hydration monitoring, and criteria for cessation, can help reduce risks associated with aspiration while supporting quality of life. Longitudinal multicentre research is recommended to evaluate safety, feasibility, hydration, respiratory outcomes, caregiver experience, and cost implications over time. Health equity analyses should examine socioeconomic and geographic disparities in access to instrumental swallow assessments and specialist dysphagia services. While this study focused on UK practice, the limited responses from Australia and New Zealand indicate emerging international interest. Future studies should therefore incorporate broader cross national scoping to understand variation in terminology, interpretation, governance, and clinical decision making across healthcare systems. National bodies should support development of consensus language and discourage use of the term protocol until paediatric specific evidence, safeguards, and standardisation exist Conclusions UK paediatric SLTs are implementing MFWPs in the absence of paediatric evidence, often extending use to high-risk populations and omitting core adult-derived safeguards. The addition of “cooled-boiled/’sterile’” water is unsupported, scientifically inaccurate, and potentially distracting from oral-care and supervision measures that reduce aspiration risk. Labelling these ad-hoc approaches a “protocol” risk conveying false certainty. Clinicians should communicate the experimental nature of MFWP use to families and teams and prioritise generation of paediatric evidence. Data Availability All data produced in the present study are available upon reasonable request to the authors. Appendix A: Survey Items, Response Formats, and Data Type View this table: View inline View popup References 1. ↵ Arvedson JC , Brodsky L , Lefton-Greif MA , editors. Pediatric Swallowing and Feeding: Assessment and Management . 3rd ed. San Diego : Plural Publishing ; 2020 . 2. Weir KA , McMahon S , Barry L , Masters IB , Chang AB . Oropharyngeal aspiration and pneumonia in children . Pediatr Pulmonol . 2007 ; 42 ( 11 ): 1024 – 31 . OpenUrl CrossRef PubMed Web of Science 3. ↵ Weir KA , McMahon S , Taylor S , Chang AB . Oropharyngeal aspiration and silent aspiration in children . Chest . 2011 ; 140 ( 3 ): 589 – 97 . OpenUrl CrossRef PubMed Web of Science 4. ↵ Velayutham P , Irace AL , Kawai K , et al. Silent aspiration: who is at risk? Laryngoscope . 2018 ; 128 ( 8 ): 1952 – 7 . OpenUrl PubMed 5. Weir KA , McMahon S , Barry L , et al. Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children . Eur Respir J . 2009 ; 33 ( 3 ): 604 – 11 . OpenUrl Abstract / FREE Full Text 6. ↵ Chou Y , Chen H , Ling Y , Wang H. Evaluation of feeding difficulties using VFSS: a 10-year paediatric experience . Pediatr Neonatol . 2023 ; 64 ( 4 ): 539 – 46 . OpenUrl 7. ↵ Stewart A , O’Connor S , Barnes S. Thickened fluids and their impact on hydration in dysphagia management . Dysphagia . 2020 ; 35 ( 6 ): 1052 – 62 . OpenUrl 8. Cichero JAY , Steele C , Duivestein J , et al. The International Dysphagia Diet Standardisation Initiative (IDDSI): development and testing . Dysphagia . 2013 ; 28 ( 2 ): 131 – 8 . OpenUrl PubMed 9. Whelan K. Inadequate fluid intakes in dysphagic patients: prevalence, predictors, and implications . Clin Nutr . 2001 ; 20 ( 5 ): 423 – 8 . OpenUrl CrossRef PubMed Web of Science 10. ↵ Mertz Garcia J , Chambers E. Managing patient adherence to thickened liquids . Am J Speech Lang Pathol . 2019 ; 28 ( 3 ): 1057 – 69 . OpenUrl 11. ↵ Panther K. The Frazier Free Water Protocol . Perspect Swallowing Swallowing Disord . 2005 ; 14 ( 1 ): 4 – 9 . OpenUrl 12. ↵ Karagiannis MJ , Chivers L , Karagiannis TC . Effects of a free water protocol on pneumonia rates in patients with dysphagia . Int J Speech Lang Pathol . 2011 ; 13 ( 3 ): 230 – 5 . OpenUrl 13. Panther K , Steele CM . The Frazier Free Water Protocol: rationale, criteria, and outcomes . Dysphagia . 2019 ; 34 (Suppl 1 ): S8 – S17 . OpenUrl 14. ↵ O’Connor S , Coyle JL . Safety and efficacy of the free water protocol in adults with dysphagia . J Speech Lang Hear Res . 2015 ; 58 ( 5 ): 1483 – 94 . OpenUrl 15. ↵ GF Strong Rehab Centre . GF Strong Water Protocol Manual . Vancouver : Vancouver Coastal Health ; 2008 . 16. ↵ Gillman A , Winkler R , Taylor NF . Implementing the Frazier Free Water Protocol: a feasibility study . Int J Speech Lang Pathol . 2017 ; 19 ( 3 ): 271 – 80 . OpenUrl 17. ↵ Splaingard ML , Hutchins B , Sulton LD , Chaudhuri G. Aspiration in rehabilitation patients: videofluoroscopic evaluation and clinical correlation . Arch Phys Med Rehabil . 1988 ; 69 ( 8 ): 637 – 40 . OpenUrl PubMed Web of Science 18. ↵ World Health Organization . Boil Water Advisory Guidance: Ensuring Safe Drinking Water . Geneva : WHO ; 2015 . 19. World Health Organization . Safe Drinking-Water from Desalination . Geneva : WHO ; 2011 . 20. Centers for Disease Control and Prevention (CDC ). Emergency Water Supply Preparation and Safety Guidelines . Atlanta, GA : CDC ; 2020 . 21. ↵ UK Drinking Water Inspectorate . Annual Report on Drinking Water Quality in England . London : DWI ; 2023 . 22. ↵ Langmore SE , Terpenning MS , Schork A , et al. Predictors of aspiration pneumonia: oral and nonoral factors . J Speech Hear Res . 1998 ; 41 ( 4 ): 923 – 34 . OpenUrl 23. El-Solh AA , Pietrantoni C , Bhat A , et al. Microbiology of aspiration pneumonia in institutionalized elderly . Am J Respir Crit Care Med . 2003 ; 167 ( 12 ): 1650 – 4 . OpenUrl CrossRef PubMed Web of Science 24. ↵ Sumi Y , Miura H , Michiwaki Y , et al. Colonization of dental plaque by respiratory pathogens in geriatric patients with aspiration pneumonia . J Med Microbiol . 2007 ; 56 (Pt 8 ): 1043 – 8 . OpenUrl View the discussion thread. Back to top Previous Next Posted November 19, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Implementation, Indications, and Rationale for Modified Free Water Protocols in Paediatric Dysphagia: A UK Survey Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Implementation, Indications, and Rationale for Modified Free Water Protocols in Paediatric Dysphagia: A UK Survey Alanna Thompson , Jessica De Bolfo medRxiv 2025.11.18.25340471; doi: https://doi.org/10.1101/2025.11.18.25340471 Share This Article: Copy Citation Tools Implementation, Indications, and Rationale for Modified Free Water Protocols in Paediatric Dysphagia: A UK Survey Alanna Thompson , Jessica De Bolfo medRxiv 2025.11.18.25340471; doi: https://doi.org/10.1101/2025.11.18.25340471 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Pediatrics Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (299) Cardiovascular Medicine (4425) Dentistry and Oral Medicine (443) Dermatology (382) Emergency Medicine (607) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1507) Epidemiology (15221) Forensic Medicine (30) Gastroenterology (1123) Genetic and Genomic Medicine (6588) Geriatric Medicine (667) Health Economics (997) Health Informatics (4524) Health Policy (1368) Health Systems and Quality Improvement (1612) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15910) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (145) Nephrology (667) Neurology (6588) Nursing (346) Nutrition (998) Obstetrics and Gynecology (1143) Occupational and Environmental Health (956) Oncology (3331) Ophthalmology (970) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (663) Pediatrics (1690) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5440) Public and Global Health (9219) Radiology and Imaging (2195) Rehabilitation Medicine and Physical Therapy (1369) Respiratory Medicine (1196) Rheumatology (593) Sexual and Reproductive Health (710) Sports Medicine (529) Surgery (710) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ffbc1157d2aad07',t:'MTc3OTQ1MjIwOQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();