FW: [Dysphagia] thickening breast milk

[CShaker at covhealth.org (Shaker, Catherine S.)]

-----Original Message-----
From: Kate Farabaugh [mailto:Kate.Farabaugh@BannerHealth.com] 
Sent: Thursday, July 08, 2004 11:59 AM
To: CShaker@covhealth.org
Subject: RE: [Dysphagia] thickening breast milk


and are we teaching this in our universities, to ask why, to search, it is
what we are so good at in other areas but seems to be lacking in dysphagia
in some instances.... oh, well, thanks!!!

>>> "Shaker, Catherine S." <CShaker@covhealth.org> 07/08/04 10:55AM >>>
You hit the nail on the head, Kate. Thickening unfortunately has become the
panacea all too often, and without evidenced based data. Too often community
therapists receive swallow study reports that talk about aspiration and
recommend compensatory thickening of liquids, yet the key question is not
addressed....why did the aspiration occur, what were the contributing
factors, how do they influence the plan for intervention? 

-----Original Message-----
From: Kate Farabaugh [mailto:Kate.Farabaugh@BannerHealth.com]
<mailto:Kate.Farabaugh@BannerHealth.com]>  
Sent: Thursday, July 08, 2004 11:25 AM
To: sorriso@adelphia.net; dysphagia@b9.com; MICHAEL@email.chop.edu
Subject: Re: [Dysphagia] thickening breast milk


And then the next question is....
was thickened breast milk tried during the study and found to be safe? is
the infant aspirating so much that we know it will put them at risk? and I
just have a hard time thinking that we couldn't identify some nipple
somewhere that would make this baby safer than thickening his formula.... a
Haberman on slow flow, an Avent multiflow or 0 month nipple? Surely these
are slow enough to allow this babe to eat regular unthickened? And then the
next question, what was causing him to aspirate, was it lack of coordination
of respiration, was it too large an oral bolus due to too soft a nipple, was
it not sufficient bolus weight to help with UES opening etc etc. I know
these are a lot of questions but this is the extent we must go before we
jump to thickening given the consequences of thickening. 
I hope these questions are helpful and not offensive as that is the
reasoning behind asking and offering. Best of luck!

Kate Farabaugh, MA, CCC-SLP
Pediatric Rehab Manager
NCMC/Banner Health System
970.350.6155
FAX 970.378.3858

WARNING: This message, and any attachments, are intended only for the  use
of the individual or entity to which it is addressed and may contain
information that is privileged, confidential and exempt from disclosure
under applicable law.  If the reader of this message is not the intended
recipient or employee/agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
distribution or copying of the communication is strictly prohibited.  If you
receive this communication in error, please notify us immediately. 
kate.farabaugh@bannerhealth.com

>>> "Staci Michael" <MICHAEL@email.chop.edu> 07/08/04 09:51AM >>>
Of course a child cannot be identified as aspirating WHILE breast
feeding!... So... clarification:  What I meant was:  "aspirating infants
whose nutrition comes from breast milk" and whose parents wish to continue
to give them breast milk (assumably identified as aspiration during an MBSS
with thin liquids from bottle despite external compensations such as nipple
or position changes).  Realistically a rare situation but nonetheless not
impossible.  
So... in this situation, an infant who is identfied as aspirating thin
liquids but safe with thickened, not able to use positional or other
compensations to produce safe swallow, therefore the only safe way to
continue oral feeds would be to thicken... obviously to be given from a
bottle.  WHAT do we thicken it with.

>>> "Kate Farabaugh" <Kate.Farabaugh@BannerHealth.com> 07/08/04 11:15AM 
>>> >>>
I would like to go back Staci to a comment you made in the beginning of your
post - aspirating breast fed babies...... how do you know a breastfed baby
is aspirating? In 23 yrs of experience I have not been able to come up with
a decent study of babe at breast, mom's get in the way physically, which
leaves the clinician to the clinical exam.... a very good exam with use of
cervial auscultation can show you best positioning etc but can not tell you
whether the babe is aspirating or not... at least not to the point of
stopping breastfeeding? 
How then are you determining this because we also all know that bottle
feeding and breastfeeding are two completely different input mechanisms and
can't be compared or equalized. So let me know how you are determining this
aspiration as I am very curious. thanks Kate

Kate Farabaugh, MA, CCC-SLP
Pediatric Rehab Manager
NCMC/Banner Health System
970.350.6155
FAX 970.378.3858

WARNING: This message, and any attachments, are intended only for the  use
of the individual or entity to which it is addressed and may contain
information that is privileged, confidential and exempt from disclosure
under applicable law.  If the reader of this message is not the intended
recipient or employee/agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
distribution or copying of the communication is strictly prohibited.  If you
receive this communication in error, please notify us immediately. 
kate.farabaugh@bannerhealth.com 

>>> "Staci Michael" <MICHAEL@email.chop.edu> 07/08/04 07:50AM >>>
Glad this was brought up and i hope we can get some feedback from everyone
who has found this to be a complicated issue!  We are currently visiting the
whole issue of thickening here with our dieticians following a few
controversial situations so this conversation is timely.  Due to the enzymes
in breast milk I have yet to find anything that will thicken breast milk for
those aspirating-breast fed babes.  I have heard simply thick will work, we
have just received samples but have not put it to test yet, and I don't know
about using with infants.  

Of further discussion I'd like feedback on is regarding thickening bottles
for babes under a year of age.  Seems many of us feel it is not good to use
commercial thickeners under a year of age (by the way can we get some
clarification on the reasons why?)- under 4 months that pretty much leaves
rice or oatmeal cereal which come with its own set of complications
(clogging, cut nipples, displaced calories) but we deal.  My question is
regarding the use of baby food as a thickener for the older infant.  Any
thoughts/opinions here?  

>>> <sorriso@adelphia.net> 07/07/04 07:45PM >>>
There was a post today on the ASHA Division 13 listserv asking about how to
thicken breast milk.  Given the debates on this list about thickening
liquids in other populations I was wondering what the consensus is about
breast milk.  So far no one has offered a solution that works and no one has
questioned why it's needed in the first place.

I'm hoping this starts a lively conversation!

Linda A. Zanchi, MA CCC-SLP


_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com 
http://lists.b9.com/mailman/listinfo/dysphagia
<http://lists.b9.com/mailman/listinfo/dysphagia>  



_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com 
http://lists.b9.com/mailman/listinfo/dysphagia
<http://lists.b9.com/mailman/listinfo/dysphagia> 
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia
<http://lists.b9.com/mailman/listinfo/dysphagia> 


Privileged/Confidential information may be contained in this message.  The
information contained in this message is intended only for the use of the
recipient(s) named above and their co-workers who are working on the same
matter.

The recipient of this information is prohibited from disclosing the
information to any other party unless this disclosure has been authorized in
advance.

If you are not intended recipient of this message or any agent responsible
for delivery of the message to the intended recipient, you are hereby
notified that any disclosure, copying, distribution or action taken in
reliance on the contents of this message is strictly prohibited.  You should
immediately destroy this message and kindly notify the sender by reply
E-Mail.

Please advise immediately if you or your employer does not consent to
Internet E-Mail for messages of this kind.  Opinions, conclusions and other
information in this message that do not relate to the official business of
the firm shall be understood as neither given nor endorsed by it.




Privileged/Confidential information may be contained in this message.  The
information contained in this message is intended only for the use of the
recipient(s) named above and their co-workers who are working on the same
matter.

The recipient of this information is prohibited from disclosing the
information to any other party unless this disclosure has been authorized in
advance.

If you are not intended recipient of this message or any agent responsible
for delivery of the message to the intended recipient, you are hereby
notified that any disclosure, copying, distribution or action taken in
reliance on the contents of this message is strictly prohibited.  You should
immediately destroy this message and kindly notify the sender by reply
E-Mail.

Please advise immediately if you or your employer does not consent to
Internet E-Mail for messages of this kind.  Opinions, conclusions and other
information in this message that do not relate to the official business of
the firm shall be understood as neither given nor endorsed by it.