HELPING PATIENTS THROUGH THICK & THIN (LIQUIDS) Presented By - - PowerPoint PPT Presentation
HELPING PATIENTS THROUGH THICK & THIN (LIQUIDS) Presented By Hillary Cooper, M.A., CCC-SLP ABOUT ME President & Co-Founder of the Dysphagia Outreach Project Owner of North Louisiana Swallow Solutions, a mobile FEES company
Rebecca Brown Kristen West
*Not a comprehensive list….
*Not a comprehensive list….
*Not a comprehensive list….
Used with Permission from Theresa Richard, M.A., CCC-SLP, BCS-S www.mobiledysphagiadiagnostics.com/blog
honey-thick liquid compared to nectar-thick or thin with a chin tuck. (Robbins et al., 2008)
tube feedings are more predictive of aspiration pneumonia (Langmore et al., 1998) <--- (This "Predictors of Aspiration" paper is a must-read for anyone working in SNFs and struggling with the ultimatum to thicken or not to thicken) Used with Permission from Theresa Richard, M.A., CCC-SLP, BCS-S www.mobiledysphagiadiagnostics.com/blog
it is a palatability issue with the patient drinking less than they would if it weren't thickened.
Used with Permission from Theresa Richard, M.A., CCC-SLP, BCS-S www.mobiledysphagiadiagnostics.com/blog
Used with Permission from Theresa Richard, M.A., CCC-SLP, BCS-S www.mobiledysphagiadiagnostics.com/blog
thickened liquids than thin liquids.
aspiration of xanthan gum thickener and aspiration of xanthan gum is worse than aspiration of plain water
development with use of honey thickened liquids.
*Not a comprehensive list….
Types of Thickeners Modified Food Starch/Cornstarch Gelmix (tapioca starch & carob bean gum) Xanthan Gum Gel Infant Rice Cereal Xanthan Gum Powder Infant Oatmeal Purathick (tapioca starch & tara gum) Food Puree/Baby Food/Yogurt
Typical Ingredients Modified food starch; Modified Cornstarch, Maltodextrin (varies by brand) Common Brands Thick-It Original; Concentrated Thick-It2; Resource ThickenUp; Walgreens Thick Now Powder; Hormel Thick&Easy; CVS Instant Food Thickener Age Range for Safe Use Age 1+ Hot/Cold Liquids Can be used with both hot & cold liquids. Does not work well with carbonated liquids. Palatability Often mixes up with clumps in it. Can taste “grainy” or “bitter” Liquids become cloudy Continues to thicken over time as it sits Cost $10-$20 per package Shelf Life 2.5 years or more (unopened) Special Diet Considerations Kosher Pareve, Vegetarian Contraindications/Allergies Gluten free (typically) Avoid if sensitive to cornstarch or corn derivatives Other Considerations May increase pulmonary injury if aspirated (Nativ-Zeltzer, 2019); Diabetic individuals need to account for the thickener in their diet because it metabolizes like sugar.
T ypical Ingredients
Xanthan Gum, Water, Soluble Fiber, Glucono Delta-lactone, Gellan Gum, Potassium Sorbate, Calcium Chloride, Citric Acid, Sodium Citrate, Guar Gum, Pectin
Common Brands
SimplyThick EasyMix
Age Range for Safe Use
>12 years old (packet says “do not use in infants or children under the age of 12 without consulting a healthcare professional) *some pediatric medical teams may consider off label usage
Hot/Cold Liquids
Works with both hot and cold & carbonated liquids. Can be frozen into ice. Does not continue to thicken over time.
Palatability
Smooth, gel consistency with no lumps or graininess. Consistency is stable over time.
Cost
$40-$70 per package
Shelf Life
12 months after manufacture date
Special Diet Considerations
Certified Kosher
Contraindications/Allergies
Not for use in individuals at high risk of necrotizing enterocolitis (NEC) Free of major known allergens
Other Considerations
Contains 1g soluble fiber per 4oz serving (nectar thick) Contains no more than 1g carbs per 4oz serving (nectar thick) Contains 20mg sodium per 4 oz serving (nectar thick)
T ypical Ingredients Maltodextrin, Xanthan gum, Erythritol, Carageenan, Ascorbic Acid (varies by brand) Common Brands
Clear DysphagiaAide, Thick-It Clear, Resource ThickenUp Clear, Hormel Thick & Easy Clear
Age Range for Safe Use
Recommended for children over age 3
Hot/Cold Liquids
Works with both hot & cold and carbonated liquids. Can be frozen into ice. Does not continue to thicken over time.
Palatability
More difficult to mix appropriately, but if done properly mixes into a smooth gel consistency. If not mixed appropriately, consistency may contain some small clumps of powder.
Cost
$10-$30 per container
Shelf Life
18 months - 3 years (varies by manufacturer)
Special Diet Considerations
Kosher
Contraindications/Allergies
Gluten Free, Lactose Free, Corn Free
Other Considerations
Contains no more than 1g carbs per 4oz serving (nectar thick)
T ypical Ingredients
Organic Tapioca Maltodextrin, Organic Tara Gum, Calcium Carbonate
Common Brands
Purathick
Age Range for Safe Use
Not for use with infants under 1 year old.
Hot/Cold Liquids
Works with hot and cold liquids Liquids will continue to thicken over time. Cold liquids thicken slower over time than hot liquids. Not recommended for carbonated beverages.
Palatability
More difficult to mix appropriately, but if done properly with a shaker cup it mixes into a smooth gel consistency. If not mixed appropriately, consistency may contain some small clumps of powder.
Cost
$20 per container
Shelf Life
2 years after manufacturing date (unopened) 30 days after opening
Special Diet Considerations
Kosher Pareve, Vegan
Contraindications/Allergies
Do not use if patient has galactosemia (rare) or allergy to galactomannans is suspected.
Other Considerations
Non-GMO, Organic
T ypical Ingredients
Organic Tapioca Maltodextrin, Organic Carob Bean Gum, Calcium Carbonate
Common Brands
Gelmix
Age Range for Safe Use
For infants >6 pounds and/or born preterm and currently under a corrected age of 2 weeks
Hot/Cold Liquids
Heat activated. Does not work well with cold liquids. Viscosity may change as the mixture cools over time.
Palatability
Despite it’s name, it is a powder, not a gel. More difficult to mix appropriately, but if done properly with a shaker cup it mixes into a smooth gel consistency. If not mixed appropriately, consistency may contain some small clumps of powder.
Cost
$25 per container
Shelf Life
2 years after manufacturing date (unopened) 30 days after opening
Special Diet Considerations
Kosher Pareve, Vegan, Non-GMO, Organic
Contraindications/Allergies
Do not use if patient has galactosemia (rare) or allergy to galactomannans is suspected.
Other Considerations
May cause transient gassiness or loose stools in the first two weeks of use which typically resolves on its own or with decreased use.
Typical Ingredients Common Brands
Gerber, beechnut, earth’s best, variety of “store brands”
Age Range for Safe Use
T erm-1 year + (most common use, medical team decisions vary)
Hot/Cold Liquids
Thickening and then reheating liquids results is significantly different flow rates indicating impact of temperature on liquid consistency and cereal thickening (Gosa and Dodrill 2017)
Palatability
Can have gritty texture may decrease palatability or change taste
Cost
Approximately $3-5 dollars per container
Shelf Life
About 2-3 months after opening
Special Diet Considerations
Contraindications/Allergies
May not be recommended for infants with complex GI histories or constipation due to side effects
Other Considerations
Can thicken over time Research has found that Formula thickened with rice cereal separates over time into thin liquid and solid residue (Gosa and Dodrill 2016) Can cause constipation Different “cuts” and particle sizes result in different thicknesses May clog nipple
Typical Ingredients Common Brands
Gerber, beechnut, earth’s best, variety of “store brands”
Age Range for Safe Use
T erm-1 year + (most common use, medical team decisions vary)
Hot/Cold Liquids
Thickening and then reheating liquids results is significantly different flow rates indicating impact of temperature on liquid consistency and cereal thickening (Gosa and Dodrill 2017)
Palatability
Can have gritty texture may decrease palatability or change taste
Cost
Approximately $3-5 dollars per container
Shelf Life
About 2-3 months after opening
Special Diet Considerations
Macronutrient shift from protein and fat to carbs which may lead to excessive weight gain (Horvath et at., 2008) Introduction of solids prior to 4 months
Contraindications/Allergies
May not be recommended for infants with complex GI histories or constipation due to side effects
Other Considerations
Formula thickened with oatmeal may over-thicken and/or separate over time into thin liquid and solid residue (Gosa and Dodrill 2016) Can cause constipation Different “cuts” and particle sizes result in different thicknesses American Academy of Pediatrics (AAP) now recommends parents of children with reflux and/or dysphagia use
T ypical Ingredients Common Brands Commercial vs homemade, wide variety of choices AND different foods to utilize including baby yogurt Age Range for Safe Use 6 months + generally (remember to consider AA) Hot/Cold Liquids ??? Palatability Will vary based on what is used can change texture/grit and alter flavor Cost Varies. Relatively inexpensive depends on brand, organic, homemade etc. Shelf Life 1-2 years for commercial baby foods depending on brand/type Special Diet Considerations Potential to introduce flavor variety to child Contraindications/Allergies Have to be cautious for potential developing allergy based on what puree you choose Other Considerations Adds nutritional value (vs empty calories) Potential for nutrient displacement Reflux considerations when picking a food type to use as a thickener Monitor GI health for stooling patterns (constipation vs loose) Lower acid baby foods include: Gerber Squash and Sweet Potatoes, Beech Nut Mixed Veggies, Corn and Sweet Potatoes, Earth’s Best Organic corn and butternut squash, organic garden vegetables
language pathologist. American Journal of Speech-Language Pathology, 14(1), 61–70.
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S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., & Loesche, W. J. (1998). Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia, 13(2), 69–81.
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adverse effect: A systematic review Infant Child and Adolescent Nutrition, 3(6): 344-350.
., & Robbins, J. (Accepted, January 2020). Front line interventions: Considerations for modifying fluids and foods for management of feeding and swallowing disorders across the lifespan. American Journal of Speech-Language Pathology.
, Szajewska H. (2008). The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials. Pediatrics,122:e1268–e1277.
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hospitalized inpatients. International Journal of Language & Communication Disorders. https://doi.org/10.1111/1460- 6984.12401
https://doi.org/10.1044/leader.FMP .24062019.8
with-food-allergies-blog/baby-formula-food-thickeners-options/\
content/uploads/2018/11/Gelmix-Product-Spec-Sheet_012019.pdf
content/uploads/2018/11/Purathick-Product-Spec-Sheet-012019.pdf
aspiration on pneumonia incidence: A randomized trial. Annals of Internal Medicine, 148(7), 509–518.
Thickeners for Your Child. [PDF File]. June 2019. https://www.seattlechildrens.org/globalassets/documents/for-patients-and-families/pfe/pe2166.pdf
for thickened liquids T
https://www.chop.edu/news/hidden-acidity-and-use-natural-thickeners-manage-pediatric-dysphagia