Clinical Aspects of Thickeners for Pediatric Gastroesophageal Reflux and Oropharyngeal Dysphagia

Duncan, Daniel R.; Larson, Kara; Rosen, Rachel

doi:10.1007/s11894-019-0697-2

Cited by 34 publications

(27 citation statements)

References 73 publications

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“…Variation in resulting liquid thickness can have detrimental effects on the person with dysphagia. Liquids that are not thick enough will not prevent airway compromise in a person with dysphagia and liquids that are too thick put the person at risk for malnutrition (especially in the case of infants and children that rely solely on formula, expressed breast milk, or other types of liquid nutritional supplements) or dehydration due to noncompliance (Cote, Germain, Dufresne, & Gagnon, 2019; Duncan, Larson, & Rosen, 2019; Gosa et al, 2020; Yoon & Yoo, 2017). There have been limited investigations into the specific variables that impact the resulting thickness of infant formulas.…”

Section: Introductionmentioning

confidence: 99%

“…The type of thickening agent used in dysphagia management affects the thickness of the resulting therapeutic infant formula consistency differently by altering the osmolality of the formula as well as the nutritional makeup of the formula (Duncan, Larson, & Rosen, 2019; Levy et al, 2019). Various studies have shown significant differences in the resulting thickness of liquids between commercially prepackaged prethickened (CPPT) beverages and instant food thickened (IFT) beverages (Adeleye & Rachal, 2007; Dewar & Joyce, 2006; Garcia, Chambers, Matta, & Clark, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Effect of mixing method on resulting thickness of infant formula

Rush

Bolland

Gosa

2020

Journal of Texture Studies

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Previous research shows that factors such as time, temperature, nutritional make‐up of a liquid, and type of thickening agent can significantly alter the resulting thickness of liquids. This study sought to determine the effect of three distinct mixing methods on the resulting thickness of ready to feed infant formulas mixed to Mildly and Moderately Thick (International Dysphagia Diet Standardization Initiative [IDDSI] Levels 2 and 3) with three different thickening agents. Eight commercially available infant formulas were mixed with three different thickening agents by three different mixing methods. The IDDSI Syringe Flow Test was used to categorize the thickened formulas. Chi square analyses were completed to determine the impact of mixing method on the thickened formulas. The majority (94%) of thickened formula combinations prepared to a target Mildly Thick consistency produced thickened formula that was thinner or thicker than the target. In contrast, the majority (76%) of thickened formula combinations prepared to a target Moderately Thick (IDDSI Level 3) consistency produced thickened formula that was equivalent to the target consistency. A statistically significant relationship was found between mixing methods and resulting IDDSI category for samples mixed to a target of Moderately Thick. The thickening agent and method of mixing must be considered carefully when preparing infant formulas to Mildly and Moderately Thick target IDDSI categories. Based on results of this study, it is recommended that providers utilize a clinical testing method, such as the IDDSI Syringe Flow Test, when attempting to create a Mildly Thick formula consistency.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of mixing method on resulting thickness of infant formula

Rush

Bolland

Gosa

2020

Journal of Texture Studies

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“…Bolus modifications such as thickened feeds may be used in some cases as the infant becomes closer to term gestation [ 66 , 67 ]. In a retrospective cohort of 137 children (including 35% preterm infants) under two years of age who had laryngeal penetration on a videofluoroscopic swallow study (VFSS), significant improvement was noted amongst children who received thickened feeds (91%) compared to those who had change in flow rate (36%) and those who received no interventions (19%) [ 66 ].…”

Section: Addressing Oral Feeding Issues Earlymentioning

confidence: 99%

Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

2021

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Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.

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“…Rice cereal-based thickeners are unsuccessful in thickening breast milk and have been associated with inconsistent thickening of formula with lack of stability over time, resulting in a nonhomogeneous mixture (11,12). Concerns of adding thickeners to any formula also include increased fluid osmolality, diarrhea and dehydration, constipation, and overweight or obesity (6)(7)(8)(9)(10). Indeed, caution must be taken when thickening a calorically concentrated formula, which might surpass the safe osmolality range leading to potential clinical complications (13).…”

Section: Introductionmentioning

confidence: 99%

Xanthan- and Rice Cereal-Based Thickeners in Infants: A Multidisciplinary Single-Center Experience

et al. 2022

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Background: Some infants aspirate thin liquids and must be fed thickened liquids in order to protect the lungs. However, thickeners have not been fully studied for safety. Xanthan-based thickeners have been implicated in the development of necrotizing enterocolitis and rice cereal-based thickeners have been associated with constipation and excessive weight gain. The aim of this study was to compare rates of adverse events between both thickeners. Methods: Single-center retrospective chart review conducted at a tertiary pediatric care center between January 2013 and July 2017. All infants deemed unsafe for oral feeding and treated with xanthan-or rice cereal-based milk thickeners were included. Data were extracted from the medical records and patients categorized according to the type of thickener. Primary outcome was the occurrence of diarrhea, constipation, overweight, and obesity at 3-6 and 6-12 months after thickener initiation. Appropriate statistical tests were used. In addition, an e-mail was sent to 14 level III Canadian Pediatric hospitals inquiring about their practice. Results: We identified 53 patients to be included in the study; 20 used xanthan-based-and 33 used rice cereal-based milk thickeners. Rates of diarrhea, constipation, overweight, and obesity at 3-6 and 6-12 months after initiation were not different between thickeners. Important variability concerning thickening practices was reported by the 8 centers that responded. Conclusions: In infants treated with milk thickeners, xanthan-based or rice cereal-based thickeners may have similar safety profiles that require further investigation including a larger number of patients.

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Clinical Aspects of Thickeners for Pediatric Gastroesophageal Reflux and Oropharyngeal Dysphagia

Cited by 34 publications

References 73 publications

Effect of mixing method on resulting thickness of infant formula

Effect of mixing method on resulting thickness of infant formula

Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

Xanthan- and Rice Cereal-Based Thickeners in Infants: A Multidisciplinary Single-Center Experience

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