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Understanding the Viscosity of Liquids used in Infant Dysphagia Management


When assessing swallowing in infants, it is critical to have confidence that the liquids presented during the swallow study closely replicate the viscosity of liquids in the infant’s typical diet. However, we lack research on rheological properties of frequently used infant formulas or breastmilk, and various forms of barium contrast media used in swallow studies. The aim of the current study was to provide objective viscosity measurements for typical infant liquid diet options and barium contrast media. A TA-Instruments AR2000 Advanced Rheometer was used to measure the viscosity of five standard infant formulas, three barium products, and two breastmilk samples. Additionally, this study measured the viscosity of infant formulas and breastmilk when mixed with powdered barium contrast in a 20 % weight-to-volume (w/v) concentration. The study findings determined that standard infant formulas and the two breastmilk samples had low viscosities, at the lower end of the National Dysphagia Diet (NDD) thin liquid range. Two specialty formulas tested had much thicker viscosities, close to the lower boundary of the NDD nectar-thick liquid range. The study showed differences in viscosity between 60 % w/v barium products (Liquid E-Z-Paque® and E-Z-Paque® powder); the powdered product had a much lower viscosity, despite identical barium concentration. When E-Z-Paque® powdered barium was mixed in a 20 % w/v concentration using water, standard infant formulas, or breastmilk, the resulting viscosities were at the lower end of the NDD thin range and only slightly thicker than the non-barium comparator liquids. When E-Z-Paque® powdered barium was mixed in a 20 % w/v concentration with the two thicker specialty formulas (Enfamil AR 20 and 24 kcal), unexpected alterations in their original viscosity occurred. These findings highlight the clinical importance of objective measures of viscosity as well as objective data on how infant formulas or breastmilk may change in consistency when mixed with barium.

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The authors gratefully acknowledge the assistance from Kimberly Ng and Dr. David James with the rheological testing conducted for this study. The authors also gratefully acknowledge Daniel Stool and Jared Fry from Intertek without whom initial rheological testing in this study would not have been possible.

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Correspondence to Jacqueline Frazier.

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The 4th and 5th authors (CEAB and CMS) acknowledge the funding from Bracco Canada to develop resources for clinicians using barium products in clinical practice.

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Frazier, J., Chestnut, A., Jackson, A. et al. Understanding the Viscosity of Liquids used in Infant Dysphagia Management. Dysphagia 31, 672–679 (2016).

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  • Dysphagia
  • Deglutition
  • Deglutition disorders
  • Viscosity
  • Infant
  • Videofluoroscopy
  • Formula
  • Barium