[Dysphagia] thickening breast milk

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

Some babies who breast and bottle feed expressed breast milk may indeed have
swallowing problems, and these are the situations I think Paula is asking
about. I have not had experience with MDs asking to thicken EBM for GER, in
fact clinically I see less GER in breastfed babies.
 
-----Original Message-----
From: Eva West [mailto:epwest@sympatico.ca] 
Sent: Wednesday, July 07, 2004 7:38 PM
To: sorriso@adelphia.net; 'Dysphagia listserv (E-mail)'
Subject: RE: [Dysphagia] thickening breast milk


I do not specialize in pediatrics, but I do see a number of infants
throughout the year.  The usual reason that I see for pediatricians ordering
thickened milk for infants is gastro-esophageal reflux (normal in smaller
amounts - "spitting up") that is so excessive that it is decreasing
available milk to the infant and affecting weight gain.  It apparently
doesn't stop the reflux, but reduces the amount that is refluxed enough
allow better weight gain. The usual thickener I see being used for formula
is infant rice cereal, but occasionally a pre-thickened formula such as
Enfalac AR.  
Because of enzymes in breast milk, rice cereal won't thicken it, and so I
have heard of Simply Thick (Xanthan Gum) being used.  I have personally
never had a client using it though, so I can't comment.  
It should be noted that thickening milk does not work for all babies with
excessive reflux.  It should also be noted that the babies that I have seen
on these thickeners generally are NOT having any sort of swallowing
difficulty, and they are NOT aspirating or having any respiratory problems
associated with the reflux, so what happens if it enters the lungs isn't
really an issue.  The issue is nutritional - they just spit back too many
calories! Eva West RD

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On Behalf
Of sorriso@adelphia.net
Sent: July 7, 2004 7:46 PM
To: dysphagia@b9.com
Subject: [Dysphagia] thickening breast milk

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


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