[Dysphagia] thickening breast milk- cautions

[eripley at yahoo.com (Irene Campbell-Taylor)]

To add to Joan's comments, the following should be considered:

The issue with gum based thickeners is not so much one of aspiration as of other serious effects, namely that the use of gum thickeners in premature infants can cause necrotizing enterocolitis.

Thickening milk feeds may cause necrotising enterocolitis.

 

Arch Dis Child Fetal Neonatal Ed 2004 May;89(3):F280   

 

Clarke P; Robinson MJ 


 

Also, in healthy, normal weight babies, thickening formula has NOT  been shown to reduce measurable reflux although it may reduce vomiting.

A systematic review of nonpharmacological and nonsurgical therapies for gastroesophageal reflux in infants.

 

Arch Pediatr Adolesc Med 2002 Feb;156(2):109-13   

 

Carroll AE; Garrison MM; Christakis DA 




We searched online bibliographic databases, including MEDLINE, EMBASE, the Cochrane Collaboration and Clinical Trials Database, and alternative medicine databases for the terms gastroesophageal reflux and infants. We selected randomized controlled trials of nonpharmacological and nonsurgical GERD therapies in otherwise healthy infants. Data were extracted from the selected articles regarding reflux, emetic episodes and intraesophageal pH. RESULTS: We identified 43 relevant studies, of which 10 met the selection criteria. These studies examined positioning, pacifier use, and feeding changes. Positioning at a 60 degree elevation in an infant seat was found to increase reflux compared with the prone position. No significant difference was shown between the flat and head-elevated prone positions. The impact of pacifier use on reflux frequency was equivocal and dependent on infant position. Although no study demonstrated a significant reflux-reducing benefit of thickened infant foods
 compared with placebo, 1 study detected a significant benefit of formula thickened with carob bean gum compared with rice flour (pH<4 for 5% vs 8% of time). Another study showed that if supplementing with dextrose 5% water or dextrose 10% water, the lower-osmolality fluid was associated with less reflux. CONCLUSIONS: Many conservative measures commonly used to treat GERD in infants have no proven efficacy. Although thickened formulas do not appear to reduce measurable reflux, they may reduce vomiting. Further studies with clinical outcomes are needed to answer questions about efficacy definitively.
AND, most importantly:

Acute lung injury after instillation of human breast milk or infant formula into rabbits' lungs.

 

Anesthesiology 1996 Jun;84(6):1386-91   

 

O'Hare B; Lerman J; Endo J; Cutz E 



BACKGROUND: Recent interest in shortening the fasting interval after ingestion of milk products demonstrated large volumes of breast milk in the stomach 2 h after breastfeeding. Although aspiration is a rare event, if it were to occur with human breast milk, it is important to understand the extent of the lung injury that might occur. Therefore, the response to instillation of acidified breast milk and infant formula in the lungs of adult rabbits was studied.

 

[Please note this. The process of aspiration is assumed to be aspiration of REFLUX, not oropharyngeal content.]

 

CONCLUSIONS: Instillation of acidified breast milk or infant formula (in a volume of 0.8 ml.kg-1 and pH level of 1.8) into rabbits' lungs induces acute lung injury of similar intensity that lasts at least 4 h.

 

[Note: a pH level of 1.8 is more acidic than normal but assumed to be equivalent to the acidity of an infant?s gastric secretions, i.e. more acidic than an adult therefore much more dangerous when aspirated.]


Jcarved@aol.com wrote:
In a message dated 7/8/2004 9:06:59 AM Central Standard Time, eripley@yahoo.com writes:


no one has questioned why it's needed in the first place.

**And that, of course, would be my first question.


Mine as well. One should also consider the potential effects on the digestive tract One of the reasons for the American Academy of Pediatrics making the recommendation change a few years ago that introduction of food (spoon feeding) be held off until 6 months of age (and remember that usually means 6 months developmental skill levels and/or corrected age at a minimum for preterm infants) has to do with infant's digestive systems. Granted the head control and independent sitting as well as tongue action changing from suckle to suck patterns all play into decisions about readiness for spoon feeding.

Considerations for thickening infant liquids must be thought through very carefully - seems to me it may be ikely to do more harm than good for at least a good many situations. Our first mandate always is to Do No Harm.

Joan Arvedson

Joan C. Arvedson, PhD, BC-NCD, BRS-S
Program Coordinator, Feeding and Swallowing Services
Children's Hospital of Wisconsin-Milwaukee
PO Box 1997, Mail Station 785
Milwaukee, WI  53201

Clinical Professor, Dept. of Pediatrics
Medical College of Wisconsin-Milwaukee

Telephone: 414-266-6548
FAX: 414-266-6189 

Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com