[Dysphagia] thickening breast milk

[scott-dailey at uiowa.edu (Dailey, Scott)]

Your point is important.  The pediatrician's I work with are very growth minded and if the baby is not growing appropriately, is when these kinds of recommednations are made.  I have seen many infants who have had enough negative experiences with feeding (many with only reflux) that the avoidance of discomfort over powers the hunger and they eat only 1 oz at a time every 2-3 hours which is not enough to grow for many of them.  I agree that thickening has been used too much, but sometimes parents refuse reflux medications and are given the "more natural" way of dealing with reflux-thickening.  Many of the infants I see do not like thickening either which really puts families and physician's in a bind.

Good discussion.

Scott Dailey, M.A., CCC-SLP
Speech-Language Pathologist II
University of Iowa Hospitals & Clinics
200 Hawkins Dr
Iowa City, IA 52242
(319)356-7030

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> ----------
> From: 	dysphagia-bounces@b9.com on behalf of Kate Farabaugh
> Sent: 	Thursday, July 8, 2004 9:58 AM
> To: 	sorriso@adelphia.net; dysphagia@b9.com; epwest@sympatico.ca
> Subject: 	RE: [Dysphagia] thickening breast milk
> 
> Hi Eva
> Unfortunately it is the concept of thickening formula or breast milk in infants being used pervasively without proven benefit that concerns me the most. 
> If one would read the baby and not make them eat 8 oz every 4 hours but would allow them to eat 2 oz every 2 hours, they would not reflux and their gastric system would be being exposed to "solids" prematurely! The infant gastric system is not ready to digest rice or xanthum gum before the estimated 5 month age.
> Unfortunately, good intentioned but poorly informed MDs and clinicians overly prescribe "thickening" when it just isn't necessary and is hurtful to the infant. 
> These babes do "talk" to us and do "tell" us when they have had enough and will gain weight if we just "listen" to them and don't overfill them at each feeding. 
> Okay, I will hop off my soapbox now and let others jump on!!
> Have a good one!
> 
> 
> Kate Farabaugh, MA, CCC-SLP
> Pediatric Rehab Manager
> NCMC/Banner Health System
> 970.350.6155
> FAX 970.378.3858
> 
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> kate.farabaugh@bannerhealth.com
> 
> >>> "Eva West" <epwest@sympatico.ca> 07/07/04 06:38PM >>>
> 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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