Can Thick It Be Used on Baby Formula
A infant born at 38 weeks has difficulty latching on. Later on the babe has been breastfeeding for weeks, the chief care medico recommends supplementing with formula. Even after transitioning to bottles, the infant still has trouble latching on. Equally the infant's frustration mounts, he displays behaviors that look like refusal. The chief care physician thinks the babe has reflux and recommends medication (to decrease inflammation) and thickened feeds (which settle better in the stomach). When the infant continues to have latching difficulty, the physician recommends stretching or making a larger hole in the nipple of the bottle to increase flow.
A 2nd babe, born prematurely due to maternal complications, is discharged from the hospital without difficulties once she is full-term. She ate well in the infirmary on thickened formula, introduced because she failed an initial swallow report. At discharge, medical staff showed the parents how to cut the nipple opening to accommodate the formula. The baby progressed well and gained weight. At five months, notwithstanding, she experiences difficulty transitioning off the thickener, so a gastroenterologist refers her to a speech communication-language pathologist.
Equally a pediatric SLP, I accept witnessed a surge in the use of thickened liquids. And, while thickening liquids is necessary in some situations, it should only exist the "crutch" SLPs use while rehabilitating the swallow machinery. Instead, I come across many SLPs using it as the solution to pediatric dysphagia.
The problems
Problem one: Stretching or cutting bottle nipples to "allow" for easier menses negates the purpose of a nipple and decreases evolution of proper oral mechanism function. With a lilliputian pressure on the bottom of the nipple from the tongue, the cut hole opens, releasing the bottle's contents. The event is a munching pattern of eating, which, in typical development, is seen subsequently in infancy.
Why does it matter if nosotros skip several steps to end upward where nosotros should exist anyway? In my patient population, when I see a "munching" design for a canteen "suck," in that location has been an associated decrease in buccal and lingual motion and lingual coordination. Having an adequate sucking motor plan is probable important when transitioning to straws and sippy cups.
Problem 2: Thickening may alter the development of pharyngeal function for swallowing because information technology allows the infant more fourth dimension to initiate a swallow (see sources). Routine intake of thickened foods may lead to motor plan evolution that is non safe for intake of a lower-viscosity liquid, which moves much more quickly (run across sources).
The scenario is similar to one in which someone lifts a 5-pound weight for six months, and then tries to exercise the same exercise with a xx-pound weight with the same accurateness. The body is non prepared and cannot handle the new load of work.
Given whatever thickness of liquid, a infant develops safe consume initiation, laryngeal sensitivity and response specific to that thickness level. Months later, during a consume study with thin liquid, the baby aspirates—much similar the example of the premature infant above. No surprise. The baby's mechanical arrangement encounters something it has not "learned" to handle. To be prepared for sparse liquids, yous probably need to "train" with thin liquids.
As SLPs, we need to aid reteach the infant to respond more quickly and efficiently to thin liquids. So we lessen the thickness, and decrease the nipple size, but now we have a new problem—the infant does not know how to suck properly. We can't go along with thickened liquids forever and we demand to teach the baby's system to tolerate sparse liquids as safely and as soon equally possible.
The solution
How can we help to ensure that babies develop sucking and swallowing accordingly? We need to advocate to exist included on NICU transition teams, and to reach out to gastroenterologists, pulmonologists and primary care physicians to become integrated in a multidisciplinary squad for advisable referrals for all feeding difficulties.
For the infant having difficulty latching, we tin begin by assessing motor function (lingual, labial and buccal). The goal is to teach the baby how to properly suck. This process begins mainly with non-nutritive sucking tasks. Yet, because not-nutritive sucking does not involve the same frequency of swallow initiations, information technology will likely be benign for developing adequate motor planning to incorporate nutritive sucking activities (see sources).
An SLP can also address the need for rehabilitating the swallow to develop the skills to consume thin liquids, equally in the second scenario. Depending on the baby'southward medical status, I begin introducing stimuli in a hierarchy—glycerin swabs, toothettes, ice chips, controlled anterior placement of thin water—to stimulate awareness and muscle response, with the goal of improving and establishing acceptable consume motor planning. Babies can usually safely absorb modest amounts of aspirated evidently water, and then we tin can safely complete these exercises to build the responses the baby needs to progress. Once we tin establish a functional nutritive sucking design, we tin so test thin formula safety and progress off thickened feeds.
Prevention
We can prevent the demand for extended amounts of feeding handling, fifty-fifty for babies who must have thickened feeds or who take a weak suck.
If a baby is on thickened feeds, the key is nipple selection. All nipples come up in sizes, typically tied to an age range. Just the age measurement is meaningless: A level ii nipple indicates 6 months-plus, just a 2-month quondam babe on thickened foods may be using a level 2. Nosotros tell our caregivers to look at the level or flow charge per unit, not the age listed. Ten- and Y-cut nipples are specifically created for thickened feeds and allow for a proper suck pattern to develop. And they eliminate the need to modify a nipple that was non meant to accommodate a thicker flow.
What if the baby tin can't suck? All babies have a suck reflex—they are born doing it (see sources). If the infant has a weak or uncoordinated suck, we tin can teach strategies and exercises to strengthen the babe's suck from the beginning. It's better to intervene early and prevent developmental problems, rather than to undo maladaptive behaviors that prolong the need for aspiration precautions and thickened feeds.
The ultimate goal is to rehabilitate the consume mechanism by improving the motor plan to increment condom and office. SLPs need to advocate to be included in multidisciplinary teams for all feeding difficulties. We can promote our value in early oral motor and eat interventions, decreasing the long-term need for thickener and the demand to undo developmental effects of overuse of thickeners.
Sources
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Feştilă, D., Ghergie, M., Muntean, A., Matiz, D., & Şerbanescu, A. (2014). Suckling and not-nutritive sucking habit: What should we know?. Clujul Medical, 87(1), eleven–14. -
Goldfield, E., Smith, V., Buonomo, C., Perez, J., & Larson, Thou. (2013). Preterm baby swallowing of thin and nectar-thick liquids: Changes in lingual-palatal coordination and relation to bolus transit. Dysphagia, 28(2), 234–244. -
Lau, C. (2015). Development of suck and swallow mechanisms in infants. Annals of Nutrition and Metabolism, 66(Supp. five), 7–14. -
Newman, R., Vilardell, Northward., Clave, P., & Speyer, R. (2016). Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: White paper by the European Society for Swallowing Disorders (ESSD). Dysphagia, 31(2), 232–249.
Author Notes
Source: https://leader.pubs.asha.org/doi/10.1044/leader.FMP.24062019.8
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