[Dysphagia] thickening breast milk

[Kate.Farabaugh at BannerHealth.com (Kate Farabaugh)]

And then the next question is....
was thickened breast milk tried during the study and found to be safe? is the infant aspirating so much that we know it will put them at risk?
and I just have a hard time thinking that we couldn't identify some nipple somewhere that would make this baby safer than thickening his formula.... a Haberman on slow flow, an Avent multiflow or 0 month nipple? Surely these are slow enough to allow this babe to eat regular unthickened?
And then the next question, what was causing him to aspirate, was it lack of coordination of respiration, was it too large an oral bolus due to too soft a nipple, was it not sufficient bolus weight to help with UES opening etc etc.
I know these are a lot of questions but this is the extent we must go before we jump to thickening given the consequences of thickening. 
I hope these questions are helpful and not offensive as that is the reasoning behind asking and offering.
Best of luck!

Kate Farabaugh, MA, CCC-SLP
Pediatric Rehab Manager
NCMC/Banner Health System
970.350.6155
FAX 970.378.3858

WARNING: This message, and any attachments, are intended only for the  use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law.  If the reader of this message is not the intended recipient or employee/agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of the communication is strictly prohibited.  If you receive this communication in error, please notify us immediately. 
kate.farabaugh@bannerhealth.com

>>> "Staci Michael" <MICHAEL@email.chop.edu> 07/08/04 09:51AM >>>
Of course a child cannot be identified as aspirating WHILE breast feeding!... So... clarification:  What I meant was:  "aspirating infants whose nutrition comes from breast milk" and whose parents wish to continue to give them breast milk (assumably identified as aspiration during an MBSS with thin liquids from bottle despite external compensations such as nipple or position changes).  Realistically a rare situation but nonetheless not impossible.  
So... in this situation, an infant who is identfied as aspirating thin liquids but safe with thickened, not able to use positional or other compensations to produce safe swallow, therefore the only safe way to continue oral feeds would be to thicken... obviously to be given from a bottle.  WHAT do we thicken it with.

>>> "Kate Farabaugh" <Kate.Farabaugh@BannerHealth.com> 07/08/04 11:15AM >>>
I would like to go back Staci to a comment you made in the beginning of your post - aspirating breast fed babies...... how do you know a breastfed baby is aspirating? In 23 yrs of experience I have not been able to come up with a decent study of babe at breast, mom's get in the way physically, which leaves the clinician to the clinical exam.... a very good exam with use of cervial auscultation can show you best positioning etc but can not tell you whether the babe is aspirating or not... at least not to the point of stopping breastfeeding? 
How then are you determining this because we also all know that bottle feeding and breastfeeding are two completely different input mechanisms and can't be compared or equalized.
So let me know how you are determining this aspiration as I am very curious. thanks
Kate

Kate Farabaugh, MA, CCC-SLP
Pediatric Rehab Manager
NCMC/Banner Health System
970.350.6155
FAX 970.378.3858

WARNING: This message, and any attachments, are intended only for the  use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law.  If the reader of this message is not the intended recipient or employee/agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of the communication is strictly prohibited.  If you receive this communication in error, please notify us immediately. 
kate.farabaugh@bannerhealth.com 

>>> "Staci Michael" <MICHAEL@email.chop.edu> 07/08/04 07:50AM >>>
Glad this was brought up and i hope we can get some feedback from everyone who has found this to be a complicated issue!  We are currently visiting the whole issue of thickening here with our dieticians following a few controversial situations so this conversation is timely.  Due to the enzymes in breast milk I have yet to find anything that will thicken breast milk for those aspirating-breast fed babes.  I have heard simply thick will work, we have just received samples but have not put it to test yet, and I don't know about using with infants.  

Of further discussion I'd like feedback on is regarding thickening bottles for babes under a year of age.  Seems many of us feel it is not good to use commercial thickeners under a year of age (by the way can we get some clarification on the reasons why?)- under 4 months that pretty much leaves rice or oatmeal cereal which come with its own set of complications (clogging, cut nipples, displaced calories) but we deal.  My question is regarding the use of baby food as a thickener for the older infant.  Any thoughts/opinions here?  

>>> <sorriso@adelphia.net> 07/07/04 07:45PM >>>
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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