Abstract
This study evaluated the flow properties of viscosity and flow rate for water and two common pediatric liquids. The flow properties of the test liquids are of interest to create a cup simulation model and “smart” prototype training cup. Two objective methods of determining flow properties were utilized: a rheometer to assess viscosity and a modified version of the International Dysphagia Diet Standardization Initiative (IDDSI) to assess flow rate. Rheometer results concluded that the pediatric supplements were less than 50 cP at all shear rates evaluated and exhibited shear-thinning properties, placing both liquids into the “thin” category. The IDDSI, which was performed according to standardized protocol and also with experimental modifications of varying syringe volumes, determined that all three test liquids had greater than 1 mL/s flow rate across all syringe types/sizes. The experimental modification of the IDDSI with 60 mL syringe volume was found to be the most consistent and applicable with discrete values obtained across all liquids tested. A flow rate factor equation can be determined with the use of a 60 mL syringe, with our laboratory setup, to create the cup simulation model. This computer-generated cup simulation model also aims to integrate engineering with clinical practice to develop a “smart” prototype training cup equipped with software to control flow rate.
Similar content being viewed by others
References
Alexander RA. Oral-motor treatment for infants and young children with cerebral palsy. Semin Speech Lang. 1987;8:87–100. https://doi.org/10.1055/s-2008-1064279.
Arvedson J, Lefton-Greif MA. Anatomy, physiology, and development of feeding. Semin Speech Lang. 1996;17(4):261–7.
Morris S, Klein M. Pre-feeding skills: a comprehensive resource for mealtime development. 2nd ed. Austin: Pro-Ed; 2000. p. 59–95.
Avery A, Baxter A. ‘Change to cup’: an audit to determine parental awareness and practices in changing from bottle to cup. J Hum Nutr Diet. 2001;14:217–23. https://doi.org/10.1046/j.1365-277X.2001.00288.x2009-3583.
Maguire JL, Birken CS, Jacobson S, Peer M, Taylor C, Khambalia A, Mekky M, Thorpe KE, Parkin P. Office-based interventions to reduce bottle use among toddlers: TARGet Kids! Pragmatic, randomized trial. Pediatrics. 2010;126:e343–50. https://doi.org/10.1542/peds.2009-3583.
Milton J, King C. Cup introduction, drink type and vitamin supplementation in preterm babies at 11–25 months. J Hum Nutr Diet. 2012;25:148–54. https://doi.org/10.1111/j.1365-277x.2012.01227.x.
Carruth B, Skinner J. Feeding behaviors and other motor development in healthy children (2–24 months). J Am Coll Nutr. 2002;21(2):88–96.
Scarborough DR, Bailey-Van Kuren M, Frey KE, Knatz ED, Lape AR, Wambaugh NM. Study of pressure and flow rate properties of training cups to characterize parameters in a developmental context. J Pediatr Rehabil Med. 2010;3:187–96. https://doi.org/10.3233/PRM-2010-0128.
American Dental Association Division of Communications. From baby bottle to cup. JADA. 2004;135:387.
Van den Hoek-Engel L, Harding C, van Gerven M, Cockerill H. Pediatric feeding and swallowing rehabilitation: an overview. J Pediatr Rehabil Med. 2017;10(2):95–105. https://doi.org/10.3233/PRM-170435.
Coster S, Schwarz E. Rheology and the swallow-safe bolus. Dysphagia. 1987;1:113–8. https://doi.org/10.1007/BF02412327.
Walters K, Jones WM. Measurement of Viscosity. In: Boyes W, editor. Instrumentation reference book. 4th ed. Burlington: Butterworth Heinemann; 2010. p. 69–75.
National Dysphagia Diet Task Force (NDD). National dysphagia diet: standardization for optimal care. Chicago, IL: American Dietetic Association; 2002.
Mills RH. Rheology overview: control of liquid viscosities in dysphagia management. Nutr Clin Pract. 1999;14:52–6. https://doi.org/10.1177/0884533699014005S11.
Steele CM, van Lieshout P, Goff H. The rheology of liquids: a comparison of clinicians’ subjective impressions and objective measurement. Dysphagia. 2003;18:182–95. https://doi.org/10.1007/s00455-002-0104-1.
Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S. Development of international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32:293–314. https://doi.org/10.1007/s00455-016-9758-y.
Abbott Laboratories Inc. Improving lives through science-based nutrition: Abbott nutrition pocket guide. The Betty Mills (2010). Accessed Electronically 27 Jan 2017.
Cichero JAY, Steele C, Duivestein J, Clave P, et al. The need for international terminology and Definitions for texture modified foods and thickened liquids used in dysphagia management: foundations of a global initiative. Curr Phys Med Rehabil Reports. 2013;1:280–91. https://doi.org/10.1007/s40141-0130024-z.
International Dysphagia Diet Standardization Initiative (IDDSI). Detailed descriptors, testing methods and evidence: Drink levels 0-4; 2015.
Arvedson JC. Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev. 2008;14:118–27. https://doi.org/10.1002/ddrr.17.
Burklow KA, Phelps AN, Schultz JR, Rudoph C. Classifying complex pediatric feeding disorders. J Pediatr Gastroenterol Nutr. 1998;27:143–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Research Involving Human Participants and/or Animals
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
The original version of this article was revised: Modifications have been made to the Figure 2 and its caption and also to the 3rd subheading under the section Methods.
Rights and permissions
About this article
Cite this article
Creech, T.N., Bailey-Van Kuren, M., Sparks, J. et al. A Comparison of Measurements of a Pediatric Supplement. Dysphagia 34, 257–268 (2019). https://doi.org/10.1007/s00455-018-9931-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00455-018-9931-6