Skip to main content
Log in

Implications of Changing the Amount of Thickener in Thickened Infant Formula for Infants with Dysphagia

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

When a dysphagic infant is prescribed thickened infant formula (TIF) as a treatment method, some clinicians determine their own addition rates of thickener to meet the specific needs of the infant rather than relying on the directions on the tin. In this study the rheological behaviour of a TIF at different addition levels of thickener was measured to determine whether there was a difference in full rheological response and in viscosity. In addition, the time taken for the TIF to reach a near-stable viscosity was also measured. One hundred grams of Karicare® infant formula was made up according to the manufacturer’s instructions and Karicare® feed thickener was added at levels of 2, 3, 4, 5, and 6 g, respectively. A strain-controlled rheometer (ARES) with Couette geometry was used to rheologically characterise the TIF at the different levels of thickener addition. There was a significant difference in viscosity between the low levels and the higher levels of addition thickener (p < 0.05). Also, the low levels of thickener addition showed Newtonian-like behaviour, whereas the higher levels of addition were shear-thinning. The time taken for the thickener to reach a near-stable viscosity was found to be 10 min. Guidelines for thickened infant formula need to take into account the different levels of thickener addition rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Arvedson JC, Brodsky L. Pediatric swallowing and feeding: assessment and management. 2nd ed. Albany: Singular Publishing; 2002.

    Google Scholar 

  2. Saigal S, Doyle LW. Preterm birth 3- an overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261–9.

    Article  PubMed  Google Scholar 

  3. Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment in normal subjects. J Speech Hear Res. 1994;37(5):1041–9.

    Article  CAS  PubMed  Google Scholar 

  4. Rempel G, Moussavi Z. The effect of viscosity on the breath-swallow pattern of young people with cerebral palsy. Dysphagia. 2005;20(2):108–12.

    Article  PubMed  Google Scholar 

  5. Cichero J, Nicholson T, Dodrill P. Liquid barium is not representative of infant formula: characterisation of rheological and material properties. Dysphagia. 2010;26(3):264–71.

    Article  PubMed  Google Scholar 

  6. Stuart S, Motz JM. Viscosity in infant dysphagia management: comparison of viscosity of thickened liquids used in assessment and thickened liquids used in treatment. Dysphagia. 2009;24(4):412–22.

    Article  PubMed  Google Scholar 

  7. de Almeida MB, de Almeida JA, Moreira ME, Novak FR. Adequacy of human milk viscosity to respond to infants with dysphagia: experimental study. J Appl Oral Sci. 2011;19(6):554–9.

    PubMed Central  PubMed  Google Scholar 

  8. Cichero JA, Nicholson TM, September C. Thickened milk for the management of feeding and swallowing issues in infants: a call for interdisciplinary professional guidelines. J Hum Lact. 2013;29(2):132–5.

    Article  PubMed  Google Scholar 

  9. Allen SS. Management of paediatric feeding problems. Chichester: Wiley; 2006.

    Google Scholar 

  10. Atheron M, Bellis-Smith N, Cichero JA, Suter M. Australian standardised terminology and definitions for texture modified foods and fluids. Nutr Diet. 2007;64(2):53–76.

    Google Scholar 

  11. Wolf L, Glass R. Clinical feeding evaluation. San Diego: Therapy Skill Builders; 1992.

    Google Scholar 

  12. Logemann J. Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed; 1998.

    Google Scholar 

  13. Huckabee ML, Pelletier CA. Treatment of adult neurogenic dysphagia. 1st ed. San Diego: Singular Publishing Group; 1998.

    Google Scholar 

  14. McCallum S. Addressing nutrient density in the context of the use of thickened liquids in dysphagia treatment. Infant Child Adolescent Nutr. 2011;3(6):11.

    Google Scholar 

  15. Koperna C, Scarnecchia K, Pierce RS. The effects of time and temperature changes on liquids thickened to nectar and honey consistencies. Contemp Issues Commun Sci Disord. 2004;31:200–4.

    Google Scholar 

  16. Perez S, Bertoft E. The molecular structures of starch components and their contribution to the architecture of starch granules: a comprehensive review. Starch-Starke. 2010;62(8):389–420.

    Article  CAS  Google Scholar 

  17. Payne C, Methven L, Fairfield C, Bell A. Consistently inconsistent: commercially available starch-based dysphagia products. Dysphagia. 2011;26(1):27–33.

    Article  PubMed  Google Scholar 

  18. O’Leary M, Hanson B, Smith C. Viscosity and non-Newtonian features of thickened fluids used for dysphagia therapy. J Food Sci. 2010;75(6):330–8.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank the input of the Paediatric Feeding Team at the Mater Children’s Hospital, Brisbane, Australia.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cindy September.

Rights and permissions

Reprints and permissions

About this article

Cite this article

September, C., Nicholson, T.M. & Cichero, J.A.Y. Implications of Changing the Amount of Thickener in Thickened Infant Formula for Infants with Dysphagia. Dysphagia 29, 432–437 (2014). https://doi.org/10.1007/s00455-014-9523-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-014-9523-z

Keywords

Navigation