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Thickening Liquids in Bottle Fed Babies: What to do? What to Avoid?

I don't know about you, but if a baby aspirates when I am doing a swallow study, it makes me NERVOUS! My first day alone on the acute care floor of the hospital, I had a 13 month old aspirate every single consistency I gave her while completing a modified barium swallow study. She had a complex medical history as well as having pneumonia and bronchitis at the same time. The mom was NOT happy with me and was convinced that I was making her aspirate. Let's just say, it was a pretty crummy day.

Fast forward 2 years later, I had a 4 month old aspirate everything and you know what, it didn't make me as nervous anymore because I was ready for the worst case scenario and I had planned ahead of time.

Here are some things to keep as mind when planning for a swallow study and information about thickened liquids.

  1. ) I typically allow the parent to feed the baby/child during swallow studies to try and simulate everyday feeding patterns. The baby/child will most likely respond better with the parent feeding them.

  2. ) Have a variety of bottle nipples out and ready. I am a fan of Dr.Browns bottles because they make so many different level nipple flows. The newborn nipple was a lifesaver for me when I had to go back to work and my baby needed to start bottle feeding. I tried the premie nipple, but it was too slow and took my baby 45+ minutes to drink 2oz. With the level 1 nipple and he was gulping and coughing. The newborn nipple was just right for my little guy to allow him to have a positive feeding experience without me there. Thank you Dr.Browns!

  3. ) Before trying a thicker consistency, try a different position. Depending on the baby's age, you can try a left or right side lying, straight upright at 90 degree angle, slightly reclined, at angle and to the left or right, etc. The babies underlying medical conditions and pathophysiology will help guide what positioning you may need to try.

  4. ) When thickening liquids...please, please, please do not cut a nipple to make a hole larger to allow the thicker liquid to go through. This makes the flow of the nipple inconsistent and can lead to the baby getting too much and not being able to manage the flow. Use a higher level nipple instead. A Dr.Browns Level 2 nipple works just fine for nectar-thick liquids.

  5. ) What do we use to thicken formula or breastmilk? Rice cereal used to be used quite a bit. We need to be careful about rice cereal for babies less than 6 months old because their digestive system might be ready for it yet. Breastmilk breaks down rice cereal and start to thin out over time. There are commercial thickeners out there made for babies. The one I am familiar with is Gel Mix Infant Thickener. DO NOT use a thickener unless it is designed for infants.

  6. ) I try to avoid thickening liquids as all costs, especially if they a premie, newborn or young infant because it can cause issues with their swallow development because the are supposed to drinking thin liquids, not thickened liquids.

  7. ) I always educated the parents as I am going along and tell them why I am trying different strategies, nipples or liquids.

  8. ) What do you do if they aspirate everything no matter what strategies you try? You take a DEEP BREATH and you let the stress go because the decision about what to do ultimately falls on the parents (sorry for the added stress parents!). You are just there to educate and teach.

Feel free to message me with any specific questions. There a millions of things I could talk about on this subject but there is only so much space on my blog.

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