Introduction:
Thickening liquids is a common recommendation when managing pediatric dysphagia and gastroesophageal reflux (Gosa & Corkins, 2015; Rosen et al., 2018). Increasing liquid viscosity may improve swallow safety and efficiency which can prevent feeding tube placement, decrease tube dependency, and/or prevent pulmonary injury from recurrent aspiration (Gosa et al., 2011; Gosa & Corkins, 2015). While thickening may be warranted in some clinical scenarios, there is evidence to suggest the potential for negative consequences, specifically acute onset of necrotizing enterocolitis (NEC) and gastric distress (Duncan et al., 2019; Gosa et al., 2011; Woods et al., 2012). Thickening of feeds should only be considered when all other therapeutic options have been exhausted and after the completion of an objective assessment (Ross, 2008). In the infant population, an SLP may alter feeding position, trial a variety of nipple flow rates and/or provide pacing strategies to assist in suck-swallow-breathe coordination (Ross & Philbin, 2011). In toddlers and older children, an SLP may trial various bolus sizes, cups, straws, and feeding positions prior to thickening (Arvedson, 2000). All compensatory strategies should be assessed for effectiveness during an imaging examination. The purpose of this resource is to identify the benefits and risks of various thickeners, so that pediatric SLPs can make an informed decision when recommending a thickening agent.
This resource includes a Pediatric Thickening Chart that you can print out and utilize as a guide with patients, caregivers, and medical providers.
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