[Dysphagia] Thickening Breastmilk for infants

[Michelle.Snead at huttvalleydhb.org.nz (Michelle Snead)]

Hello
I had a query from one of the nurses on our special care baby unit
about how much thickener to use in breastmilk.  Thickener is often used
as the initial approach to reducing reflux in the babies here. There is
some concern with the fact that breastmilk does not thicken the same as
formula and may of the nurses on the ward are not using the appropriate
amount.  It also makes it tricky because many of the babies are taking
less than 100ml which is the proportion commonly used for measuring
thickener.   Does anyone know where I can find information on this? 
Cheers
Michelle Snead

>>> Irene Campbell-Taylor <eripley@yahoo.com> 12/10/2005 10:38 a.m.
>>>
Re: [Dysphagia] Pharyngeal reflex Triggering
To: Luckyluck <astapane@spark.net.gr>

The answer to your question depends on whether or not you want to know
about initiation of the swallow during VFSS - an unnatural situation -
or what happens in real life. The two have little in common. Please
see:

Dua KS; Ren J; Bardan E; Xie P; Shaker R. Coordination of deglutitive
glottal function and pharyngeal bolus transit during normal
eating.Gastroenterology, 112:73-83  1997 

Deglutitive glottal function during the preparatory phase of swallowing


and its coordination with bolus transit during normal eating are
important for airway protection. 

The aim of this study was to examine this coordination during
consumption of a normal meal. 

Fifteen healthy volunteers were studied using a videoendoscopic and
videofluoroscopic 

technique.  A total of 207 liquid and 470 solid bolus swallows were
analyzed. 

In 60% of liquid and 76% of solid food swallows, the bolus was seen in
the pharynx 

before a swallow was initiated. Entry of boluses into the pharynx was
associated with 

brief partial adduction of the vocal cords. Solid food entered and
traversed the
pharynx at the midline, whereas liquid bolus was split around the
larynx and rejoined in the hypopharynx.Swallowing was initiated
significantly earlier when bolus made contact with the upper third of
the epiglottis compared with vallecula or pyriform sinuses. In more than
half of the instances, during normal eating, food enters the pharynx
during the preparatory phase before a swallow is initiated, the path of
pharyngeal transit of solid bolus is different from that of liquid
bolus, and the epiglottal edge appears to be the most sensitive trigger
zone for swallowing.


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