Use of Thickened Liquids to Manage Feeding Difficulties in Infants: A Pilot Survey of Practice Patterns in Canadian Pediatric Centers

Dion, Stephanie; Duivestein, Janice; Pierre, A; Harris, Susanna

doi:10.1007/s00455-015-9625-2

Cited by 35 publications

(17 citation statements)

References 32 publications

(42 reference statements)

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“…Currently, the provision of thickened liquids is a commonly used intervention to facilitate safe milk ingestion in the presence of thin liquid aspiration. 35,36 This intervention is aimed at slowing the rate of milk flow through the pharynx in effort to promote a timely initiation of swallow and obtain complete airway protection. Although this intervention may have beneficial effects for some, the ability to achieve these effects is limited by the nature and severity of the swallowing impairment.…”

Section: Discussionmentioning

confidence: 99%

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Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment

McGrattan

McGhee

DeToma

et al. 2017

Congenital Heart Disease

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Background Deficits in swallowing physiology are a leading morbidity for infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliation. Despite the high prevalence of this condition, the underlying deficits that cause this post-operative impairment remain poorly understood. Objective Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery. Methods Postoperative fiberoptic laryngoscopies and videofluoroscopic swallow studies (VFSS) were conducted sequentially on infants with functional single ventricles following stage 1 palliative surgery. Infants were dichotomized as having normal or impaired laryngeal function based on laryngoscopy findings. VFSS were evaluated frame-by-frame using a scale that quantifies performance within 11 components of swallowing physiology. Physiologic attributes within each component were categorized as high functioning or low functioning based on their ability to support milk ingestion without bolus airway entry. Results Thirty-six infants (25 male) were included in the investigation. Twenty-four underwent the Norwood procedure and twelve underwent the Hybrid procedure. Low function physiologic patterns were observed within multiple swallowing components during the ingestion of thin barium as characterized by ≥ 4 sucks per swallow (36%), initiation of pharyngeal swallow below the level of the valleculae (83%), and incomplete late laryngeal vestibular closure (56%) at the height of the swallow. Swallowing deficits contributed to aspiration in 50% of infants. Although nectar thick liquids reduced the rate of aspiration (p=0.006), aspiration rates remained high (27%). No differences in rates of penetration or aspiration were observed between infants with normal and impaired laryngeal function. Conclusions Deficits in swallowing physiology contribute to penetration and aspiration following stage 1 palliation among infants with normal and impaired laryngeal function. Although thickened liquids may improve airway protection for select infants, they may inhibit their ability to extract the bolus and meet nutritional needs.

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Section: Discussionmentioning

confidence: 99%

“…Currently, the provision of thickened liquids is a commonly used intervention to facilitate safe milk ingestion in the presence of thin liquid aspiration . This intervention is aimed at slowing the rate of milk flow through the pharynx in effort to promote a timely initiation of swallow and obtain complete airway protection.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment

McGrattan

McGhee

DeToma

et al. 2017

Congenital Heart Disease

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“…For example infant formula needs significantly longer to thicken and results in a higher final viscosity [54*]; concern was a reported of the lack of guidance [55]. Thickening occurs more slowly at refrigerated temperature (5°C) and even more slowly for refrigerated milk, which may require 45-60 minutes [56] and reaches a higher final viscosity, increasing with fat content [57*] and protein content [58].…”

Section: Current Practice and Standardisation Approaches Internationallymentioning

confidence: 99%

A review of diet standardization and bolus rheology in the management of dysphagia

Hanson

2016

Current Opinion in Otolaryngology & Head and Neck Surgery

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Purpose: Texture modification is a widespread practice as a strategy for the management of dysphagia and can be very effective in individual cases. However, it is often performed in a qualitative, subjective manner and practices vary internationally according to multiple sets of national guidelines. This paper aims to identify best practice by reviewing the theory and practice of texture modification, focussing on recent advances. Recent findings:Instrumental assessment of texture modification in-vivo is challenging, but studies including rheology and perception have indicated that fluid viscosity is only one of many factors affecting texture modification in practice. Systematic reviews have identified a historical lack of high-quality clinical evidence, but recent controlled studies are beginning to identify positive and negative aspects of thickened fluids. Research and practice to date have been limited by the lack of control and standardisation of foods and drinks. However in 2015 a notfor-profit organisation, the International Dysphagia Diet Standardisation Initiative, has published a framework for texture modification from thin liquids to solid foods based on all the existing documentation and guidance, and the -limited-available clinical evidence. Summary:Rheology exists in the lab, however normal practice is often subjective or lacking control and standardisation. In the near future, cohesion of practice and the availability of practical standardisation tools may increase awareness and use of rheology. KeywordsDysphagia, Swallowing, Rheology, Viscosity, Texture modification Key points •The relationships between rheology and swallowing are beginning to be characterised using oral pressure sensing and videofluoroscopy, together with careful control of bolus rheology.• It is becoming clearer that viscosity alone is not sufficient to categorise texture modification.• Literature to date shows a trend for reduced aspiration with increased thickness of liquids, and increased residue with some thicker consistencies, however evidence is scarce.• An inconsistent approach to definition of texture modification techniques has been limiting the collation of a coherent evidence base.• A new international standard (IDDSI) has been created, drawing on available evidence and including practical objective measures.

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“…In powdered IMF, reducing the protein content to as low as 9.77 g protein/100 g did not cause a significant impact on physical stability and shelf-life [26]. However, in RTF liquid IMF, a higher ratio of α-Lac to β-Lg reduces the viscosity and induces rapid sedimentation during storage, as observed in UHT-treated products; and hence, the addition of thickener and stabilizer is suggested to manage the viscosity and sedimentation, respectively [27,28,29]. Furthermore, Crowley et al [27] reported increased α-Lac reduced heat-induced coagulation in a model whey protein-dominant IMF.…”

Section: Introductionmentioning

confidence: 99%

Hypoallergenic and Low-Protein Ready-to-Feed (RTF) Infant Formula by High Pressure Pasteurization: A Novel Product

Wazed

Farid

2019

Foods

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Infant milk formula (IMF) is designed to mimic the composition of human milk (9–11 g protein/L); however, the standard protein content of IMF (15 g/L) is still a matter of controversy. In contrast to breastfed infants, excessive protein in IMF is associated with overweight and symptoms of metabolic syndrome in formula-fed infants. Moreover, the beta-lactoglobulin (β-Lg) content in cow milk is 3–4 g/L, whereas it is not present in human milk. It is considered to be a major reason for cow milk allergy in infants. In this respect, to modify protein composition, increasing the ratio of alpha-lactalbumin (α-Lac) to β-Lg would be a pragmatic approach to develop a hypoallergenic IMF with low protein content. Such a formula would ensure the necessary balance of essential amino acids, as 123 and 162 amino acid residues are available in α-Lac and β-Lg, respectively. Hence, in this study, a pasteurized form of hypoallergenic and low-protein ready-to-feed (RTF) formula, a new product, is developed to retain heat-sensitive bioactives and other components. Therefore, the effects of high pressure processing (HPP) under 300–600 MPa at approximately 20–40 °C and HTST pasteurization (72 °C for 15 and 30 s) were investigated and compared. The highest ratio of α-Lac to β-Lg was achieved after HPP (600 MPa for 5 min applied at 40.4 °C), which potentially explains the synergistic effect of HPP and heat on substantial denaturation of β-Lg, with significant retention of α-Lac in reconstituted IMF. Industrial relevance: This investigation showed the potential production of a pasteurized RTF formula, a niche product, with a reduced amount of allergenic β-Lg.

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Use of Thickened Liquids to Manage Feeding Difficulties in Infants: A Pilot Survey of Practice Patterns in Canadian Pediatric Centers

Cited by 35 publications

References 32 publications

Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment

Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment

A review of diet standardization and bolus rheology in the management of dysphagia

Hypoallergenic and Low-Protein Ready-to-Feed (RTF) Infant Formula by High Pressure Pasteurization: A Novel Product

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