To follow up on Mallory’s post on Dysphagia, GERD, and Silent Aspiration in children, in this post we discuss the use of thickeners. We’ll also share some thickener options and questions you should ask the healthcare team.
Your child’s healthcare team may recommend a thickener to help manage:
- reflux (“GER”), also called spitting up in infants
- dysphagia (trouble or difficulty swallowing), and/or
- aspiration (when fluid or food getting into the lungs)
If your little one shows signs of reflux, dysphagia or aspiration, see a doctor to determine exactly what condition needs to be managed. Always check with your child’s doctor and/or feeding specialist or speech pathologist to see if a food thickener is appropriate for your little one before trying one.
Reflux is a possible sign of food allergies, particularly in infants. Getting allergies under control with a hypoallergenic formula, like Neocate, usually takes care of signs and symptoms. So when reflux is a symptom of food allergies, Neocate can help. A healthcare professional can diagnose a food allergy. If you suspect your child may have a food allergy, these 8 questions can help you talk to your healthcare professional about your concerns.
Also, children with eosinophilic esophagitis (EoE) can have symptoms of dysphagia and often have symptoms of reflux. EoE is caused by food allergies and can be managed effectively by eliminating the allergens in your child’s diet. Thickening their food or formula may not be needed once the allergens are removed if the reflux also comes under control.
Thickening Liquids and Foods
If your child does have reflux, there are typically strategies that are tried before thickeners. These can include smaller, more frequent feedings and upright positions. Your healthcare team should advise what you should try first and in what order. They can tell you how long to try before moving on to new strategies.
If other strategies aren’t successful, it may be necessary to thicken liquids and runny foods. This can help make them easier to swallow and keep down. When fluids are too thin or liquid, some children have trouble using their tongues and the muscles that help to swallow correctly. This can cause liquid to get caught in the airway passage and then get into their lungs, or aspirate. Aspiration – – can be dangerous! Thickening the formula and other fluids can help the liquids stay together during swallowing. This can decrease the risk of aspiration.
Sometimes thin liquids don’t stay down, particularly in infants. Many infants spit up, and it’s often not problematic and goes away eventually. Other times, the amount and frequency of spit up may concern the healthcare team. Thickening formula or breast milk may help to minimize spit up frequency and volume.
Foods as Thickeners
Healthcare professionals may suggest adding something to formula or expressed breast milk to thicken it for some infants with reflux. Some healthcare team recommend adding certain foods to achieve this. However, it’s important to note that there is not consensus on this: Not all healthcare teams agree that this is an acceptable approach; And there isn’t consensus on which food items should be used and in what amounts. Using foods as thickeners carries known risks.
If your healthcare team suggests adding a food to thicken formula or other liquids:
- They should specify what food and how much to add to your little one’s bottle.
- Don’t be afraid to ask for explicit instructions and ask questions.
- For infants, formula thickened with foods may not flow through a nipple well.
Commercial Thickeners
There are some commercial thickeners on the market that may be options, depending on your child’s age. These have been studied more extensively than food-based thickeners. If your child has food allergies, ensure the thickener doesn’t contain any of their allergens. You should read labels and call the company that makes the thickener to be sure it’s free of your child’s allergens. A few options in the market, and the manufacturer guidance on who can use the product, include:
- GelMix (not for use with infants under 42 weeks gestational age or with infants under six pounds)
- ThickenUp (only appropriate for use in individuals greater than 3 years old)
- Thick-It (not for use with infants under 37 weeks gestational age, consult physician before use with any infant)
- SimplyThick (DO NOT USE IN INFANTS OR CHILDREN WITHOUT CONSULTING A PHYSICIAN)
Listing these thickeners here is not an endorsement. We do not recommend any specific commercial thickeners for use with Neocate formulas: Any should work. If your healthcare team recommends that you should thicken your Neocate formula, ask what thickener they recommend.
We hope this helped! What other questions do you have about thickeners?
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Nutrition Specialists
Last updated April 4, 2018
