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

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Abstract

Improved survival rates of sick or preterm infants have resulted in an increase of observed feeding difficulties. One common method for managing feeding difficulties in infants is to manipulate liquid viscosity by adding thickening agents to formula or expressed breast milk. Concerns regarding the lack of clinical practice guidelines for the use of this strategy have been raised in the literature and in clinical settings for several years. This study aimed to survey feeding clinicians working in major Canadian pediatric centers to identify current practice patterns for use of thickened liquids in managing feeding difficulties of infants and to justify the need for standardization of this practice. A web-based pilot survey was developed using Fluidsurveys software. The questionnaire contained 37 questions targeting the process of prescribing thickeners, choice of thickener, awareness of issues, and inconsistencies raised in the literature about thickener use and how to address them. A total of 69 questionnaire responses were analyzed using descriptive statistics and inductive thematic analysis methods. Our study results indicate that thickened liquids continue to be broadly used to manage feeding difficulties in Canadian infants, despite numerous areas of concern related to their use raised by our respondents. While clear practice patterns for assessment and management were observed among the respondents, some areas of practice did not reflect recent published research or experts’ opinion. Further research to develop a systematic approach for assessment, intervention, and follow-up is warranted to guide clinicians in this complex decision-making process.

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Notes

  1. “Not intended for use with preterm or infants under 12 months of age or children under the age of 12 years with a history of NEC” [17].

  2. “This product is only suitable for individuals greater than 3 years old” [33].

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Acknowledgment

The authors thank Dr. Ben Mortenson for his input on the design validity of the questionnaire.

Conflict of interest

All authors are free of professional areas of conflict of interest.

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Authors and Affiliations

  1. BC Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada

    Stephanie Dion & Astrid St. Pierre

  2. Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada

    Janice A. Duivestein

  3. Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada

    Susan R. Harris

Authors
  1. Stephanie Dion
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  2. Janice A. Duivestein
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  3. Astrid St. Pierre
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  4. Susan R. Harris
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Corresponding author

Correspondence to Stephanie Dion.

Appendix: Transcript of the Online Questionnaire

Appendix: Transcript of the Online Questionnaire

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Dion, S., Duivestein, J.A., St. Pierre, A. et al. Use of Thickened Liquids to Manage Feeding Difficulties in Infants: A Pilot Survey of Practice Patterns in Canadian Pediatric Centers. Dysphagia 30, 457–472 (2015). https://doi.org/10.1007/s00455-015-9625-2

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  • DOI: https://doi.org/10.1007/s00455-015-9625-2

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