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Published in: Dysphagia 3/2022

01-06-2022 | Dysphagia | Original Article

Thickened Liquids Using Pureed Foods for Children with Dysphagia: IDDSI and Rheology Measurements

Authors: Laura Brooks, Jianshan Liao, Jaclyn Ford, Sarah Harmon, Victor Breedveld

Published in: Dysphagia | Issue 3/2022

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Abstract

Children with dysphagia, or swallowing disorder, are at an increased risk for developing respiratory compromise, failure to thrive, and aversion. Thickened liquids can be recommended for children with dysphagia, if shown to be effective on instrumental examination and if strategies/interventions with thin liquids are not successful. Thickened liquids have many benefits, including creating a more cohesive bolus, slowing oropharyngeal transit time, and reducing aspiration. However, preparing thickened liquids with commercially available thickeners can result in poor compliance due to concerns regarding taste, texture, accessibility, cost, thickness variability, and potential negative impact of these substances on a child’s immature digestive tract. The purpose of this study was to determine if liquids could be successfully thickened with widely available, commercial pureed foods, and to assess how these mixtures compare to starch and gum based thickening agents. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was performed for each sample of puree thickened liquids, gum based thickened water, and cornstarch based thickened water. In addition, rheology testing was performed on each category of the samples to measure viscosity at various shear rates and temperatures, and to assess the presence of yield stress. Results revealed that liquids thickened with smooth textured purees were comparable to commercial starch and gum based thickeners, and may be offered as a viable alternative.
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Literature
2.
go back to reference Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.PubMedPubMedCentralCrossRef Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.PubMedPubMedCentralCrossRef
3.
4.
go back to reference Coyle JL, Davis LA, Easterling C, Graner DE, Langmore S, Leder SB, Lefton-Greif MA, Leslie P, Logemann JA, Mackay L, Murray JT, Sonies B, Steele CM, Martin-Harris B. Oropharyngeal dysphagia assessment and treatment efficacy: setting the record straight (response to Campbell-Taylor). J Am Med Dir Assoc. 2009;10(1):62–6.PubMedCrossRef Coyle JL, Davis LA, Easterling C, Graner DE, Langmore S, Leder SB, Lefton-Greif MA, Leslie P, Logemann JA, Mackay L, Murray JT, Sonies B, Steele CM, Martin-Harris B. Oropharyngeal dysphagia assessment and treatment efficacy: setting the record straight (response to Campbell-Taylor). J Am Med Dir Assoc. 2009;10(1):62–6.PubMedCrossRef
5.
go back to reference Gurberg J, Birnbaum R, Daniel SJ. Laryngeal penetration on videofluoroscopic swallowing study is associated with increased pneumonia in children. Int J Pediatr Otorhinolaryngol. 2015;79(11):1827–30.PubMedCrossRef Gurberg J, Birnbaum R, Daniel SJ. Laryngeal penetration on videofluoroscopic swallowing study is associated with increased pneumonia in children. Int J Pediatr Otorhinolaryngol. 2015;79(11):1827–30.PubMedCrossRef
6.
go back to reference Brooks L. Treatment for Dysphagia. In: Ongkasuwan J, Chiou EH, editors. Pediatric Dysphagia: challenges and controversies. Cham: Springer; 2018. p. 147–61.CrossRef Brooks L. Treatment for Dysphagia. In: Ongkasuwan J, Chiou EH, editors. Pediatric Dysphagia: challenges and controversies. Cham: Springer; 2018. p. 147–61.CrossRef
7.
8.
go back to reference Simon M, Collins MS. The pediatric lung and aspiration. SIG 13 Perspect Swal Swal Disord (Dysph). 2013;22(4):142–54.CrossRef Simon M, Collins MS. The pediatric lung and aspiration. SIG 13 Perspect Swal Swal Disord (Dysph). 2013;22(4):142–54.CrossRef
10.
go back to reference Weckmueller J, Easterling C, Arvedson J. Preliminary temporal measurement analysis of normal oropharyngeal swallowing in infants and young children. Dysphagia. 2011;26(2):135–43.PubMedCrossRef Weckmueller J, Easterling C, Arvedson J. Preliminary temporal measurement analysis of normal oropharyngeal swallowing in infants and young children. Dysphagia. 2011;26(2):135–43.PubMedCrossRef
11.
go back to reference Cichero JA. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12(1):54.PubMedPubMedCentralCrossRef Cichero JA. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12(1):54.PubMedPubMedCentralCrossRef
12.
go back to reference Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16(2):119–22.PubMedCrossRef Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16(2):119–22.PubMedCrossRef
13.
go back to reference Arvedson J, Rogers B, Buck G, Smart P, Msall M. Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol. 1994;28(2–3):173–81.PubMedCrossRef Arvedson J, Rogers B, Buck G, Smart P, Msall M. Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol. 1994;28(2–3):173–81.PubMedCrossRef
14.
go back to reference Clavé P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008;27(6):806–15.PubMedCrossRef Clavé P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008;27(6):806–15.PubMedCrossRef
15.
go back to reference Garon BR, Sierzant T, Ormiston C. Silent aspiration: results of 2,000 video fluoroscopic evaluations. J Neurosci Nurs. 2009;41(4):178–85.PubMedCrossRef Garon BR, Sierzant T, Ormiston C. Silent aspiration: results of 2,000 video fluoroscopic evaluations. J Neurosci Nurs. 2009;41(4):178–85.PubMedCrossRef
16.
go back to reference Gosa M, Schooling T, Coleman J. Thickened liquids as a treatment for children with dysphagia and associated adverse effects: a systematic review. ICAN Infant Child Adolesc Nutr. 2011;3(6):344–50.CrossRef Gosa M, Schooling T, Coleman J. Thickened liquids as a treatment for children with dysphagia and associated adverse effects: a systematic review. ICAN Infant Child Adolesc Nutr. 2011;3(6):344–50.CrossRef
17.
go back to reference Cichero JA, Lam P. Thickened liquids for children and adults with oropharyngeal dysphagia: the complexity of rheological considerations. J Gastroenterol Hepatol Res. 2014;3(5):1073–1079. Cichero JA, Lam P. Thickened liquids for children and adults with oropharyngeal dysphagia: the complexity of rheological considerations. J Gastroenterol Hepatol Res. 2014;3(5):1073–1079.
18.
go back to reference Newman R, Vilardell N, Clavé P, Speyer R. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders (ESSD). Dysphagia. 2016;31(2):232–49.PubMedPubMedCentralCrossRef Newman R, Vilardell N, Clavé P, Speyer R. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders (ESSD). Dysphagia. 2016;31(2):232–49.PubMedPubMedCentralCrossRef
19.
go back to reference Clavé P, De Kraa M, Arreola V, Girvent M, Farre R, Palomera E, Serra-Prat M. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24(9):1385–94.PubMedCrossRef Clavé P, De Kraa M, Arreola V, Girvent M, Farre R, Palomera E, Serra-Prat M. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24(9):1385–94.PubMedCrossRef
20.
go back to reference Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol Gastrointest Liver Physiol. 1990;258(5):675–81.CrossRef Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol Gastrointest Liver Physiol. 1990;258(5):675–81.CrossRef
21.
go back to reference Taniguchi H, Tsukada T, Ootaki S, Yamada Y, Inoue M. Correspondence between food consistency and suprahyoid muscle activity, tongue pressure, and bolus transit times during the oropharyngeal phase of swallowing. J Appl Physiol. 2008;105(3):791–9.PubMedCrossRef Taniguchi H, Tsukada T, Ootaki S, Yamada Y, Inoue M. Correspondence between food consistency and suprahyoid muscle activity, tongue pressure, and bolus transit times during the oropharyngeal phase of swallowing. J Appl Physiol. 2008;105(3):791–9.PubMedCrossRef
22.
go back to reference Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Lang Hear Res. 1994;37(5):1041–9.CrossRef Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Lang Hear Res. 1994;37(5):1041–9.CrossRef
23.
go back to reference Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T, Lazar R, Halper A. Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients. Arch Phys Med Rehabil. 1993;74(10):1066–70.PubMedCrossRef Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T, Lazar R, Halper A. Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients. Arch Phys Med Rehabil. 1993;74(10):1066–70.PubMedCrossRef
25.
go back to reference Krummrich P, Kline B, Krival K, Rubin M. Parent perception of the impact of using thickened fluids in children with dysphagia. Pediatr Pulmonol. 2017;52(11):1486–94.PubMedCrossRef Krummrich P, Kline B, Krival K, Rubin M. Parent perception of the impact of using thickened fluids in children with dysphagia. Pediatr Pulmonol. 2017;52(11):1486–94.PubMedCrossRef
26.
go back to reference Coon ER, Srivastava R, Stoddard GJ, Reilly S, Maloney CG, Bratton SL. Infant videofluoroscopic swallow study testing, swallowing interventions, and future acute respiratory illness. Hosp Pediatr. 2016;6(12):707–13.PubMedCrossRef Coon ER, Srivastava R, Stoddard GJ, Reilly S, Maloney CG, Bratton SL. Infant videofluoroscopic swallow study testing, swallowing interventions, and future acute respiratory illness. Hosp Pediatr. 2016;6(12):707–13.PubMedCrossRef
27.
go back to reference McSweeney ME, Kerr J, Amirault J, Mitchell PD, Larson K, Rosen R. Oral feeding reduces hospitalizations compared with gastrostomy feeding in infants and children who aspirate. J Pediatr. 2016;170:79–84.PubMedCrossRef McSweeney ME, Kerr J, Amirault J, Mitchell PD, Larson K, Rosen R. Oral feeding reduces hospitalizations compared with gastrostomy feeding in infants and children who aspirate. J Pediatr. 2016;170:79–84.PubMedCrossRef
28.
go back to reference Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516–54.PubMedPubMedCentralCrossRef Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516–54.PubMedPubMedCentralCrossRef
29.
go back to reference Duncan DR, Larson K, Rosen RL. Clinical aspects of thickeners for pediatric gastroesophageal reflux and oropharyngeal dysphagia. Curr Gastroenterol Rep. 2019;21(7):30.PubMedCrossRef Duncan DR, Larson K, Rosen RL. Clinical aspects of thickeners for pediatric gastroesophageal reflux and oropharyngeal dysphagia. Curr Gastroenterol Rep. 2019;21(7):30.PubMedCrossRef
30.
go back to reference Orenstein SR, Magill HL, Brooks P. Thickening of infant feedings for therapy of gastroesophageal reflux. J Pediatr. 1987;110(2):181–6.PubMedCrossRef Orenstein SR, Magill HL, Brooks P. Thickening of infant feedings for therapy of gastroesophageal reflux. J Pediatr. 1987;110(2):181–6.PubMedCrossRef
31.
go back to reference Bridget P. Use of fluid thickener to reduce dysphagia risk. Nurs Times. 2014;110(12):16–8.PubMed Bridget P. Use of fluid thickener to reduce dysphagia risk. Nurs Times. 2014;110(12):16–8.PubMed
32.
go back to reference Dewar RJ, Joyce MJ. Time-dependent rheology of starch thickeners and the clinical implications for dysphagia therapy. Dysphagia. 2006;21(4):264–9.PubMedCrossRef Dewar RJ, Joyce MJ. Time-dependent rheology of starch thickeners and the clinical implications for dysphagia therapy. Dysphagia. 2006;21(4):264–9.PubMedCrossRef
33.
go back to reference Garcia JM, Chambers E, Matta Z, Clark M. Viscosity measurements of nectar-and honey-thick liquids: product, liquid, and time comparisons. Dysphagia. 2005;20(4):325–35.PubMedCrossRef Garcia JM, Chambers E, Matta Z, Clark M. Viscosity measurements of nectar-and honey-thick liquids: product, liquid, and time comparisons. Dysphagia. 2005;20(4):325–35.PubMedCrossRef
34.
go back to reference Shim JS, Oh BM, Han TR. Factors associated with compliance with viscosity-modified diet among dysphagic patients. Ann Rehabil Med. 2013;37(5):628–32.PubMedPubMedCentralCrossRef Shim JS, Oh BM, Han TR. Factors associated with compliance with viscosity-modified diet among dysphagic patients. Ann Rehabil Med. 2013;37(5):628–32.PubMedPubMedCentralCrossRef
35.
go back to reference Cichero JA, Hay G, Murdoch BE, Halley PJ. Videofluoroscopic fluids versus mealtime fluids: differences in viscosity and density made clear. J Med Speech Lang Pathol. 1997;5(3):203–15. Cichero JA, Hay G, Murdoch BE, Halley PJ. Videofluoroscopic fluids versus mealtime fluids: differences in viscosity and density made clear. J Med Speech Lang Pathol. 1997;5(3):203–15.
36.
go back to reference Steele CM, Alsanei WA, Ayanikalath S, Barbon CE, Chen J, Cichero JA, Coutts K, Dantas RO, Duivestein J, Giosa L, Hanson B. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015;30(1):2–26.PubMedCrossRef Steele CM, Alsanei WA, Ayanikalath S, Barbon CE, Chen J, Cichero JA, Coutts K, Dantas RO, Duivestein J, Giosa L, Hanson B. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015;30(1):2–26.PubMedCrossRef
37.
go back to reference Borwankar RP. Food texture and rheology: a tutorial review. In: Rheology of foods. Amsterdam: Elsevier; 1992. p. 1–16. Borwankar RP. Food texture and rheology: a tutorial review. In: Rheology of foods. Amsterdam: Elsevier; 1992. p. 1–16.
38.
go back to reference Cook DJ, Hollowood TA, Linforth RS, Taylor AJ. Oral shear stress predicts flavour perception in viscous solutions. Chem Senses. 2003;28(1):11–23.PubMedCrossRef Cook DJ, Hollowood TA, Linforth RS, Taylor AJ. Oral shear stress predicts flavour perception in viscous solutions. Chem Senses. 2003;28(1):11–23.PubMedCrossRef
39.
go back to reference Macosko CW. Rheology: principles, measurements, and applications. Hoboken: Wiley-VCH; 1994. Macosko CW. Rheology: principles, measurements, and applications. Hoboken: Wiley-VCH; 1994.
40.
go back to reference Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293–314.PubMedCrossRef Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293–314.PubMedCrossRef
41.
go back to reference Glassburn DL, Deem JF. Thickener viscosity in dysphagia management: variability among speech-language pathologists. Dysphagia. 1998;13(4):218–22.PubMedCrossRef Glassburn DL, Deem JF. Thickener viscosity in dysphagia management: variability among speech-language pathologists. Dysphagia. 1998;13(4):218–22.PubMedCrossRef
42.
43.
go back to reference Beal J, Silverman B, Bellant J, Young TE, Klontz K. Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. J Pediatr. 2012;161(2):354–6.PubMedCrossRef Beal J, Silverman B, Bellant J, Young TE, Klontz K. Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. J Pediatr. 2012;161(2):354–6.PubMedCrossRef
44.
go back to reference Woods CW, Oliver T, Lewis K, Yang Q. Development of necrotizing enterocolitis in premature infants receiving thickened feeds using SimplyThick®. J Perinatol. 2012;32(2):150.PubMedCrossRef Woods CW, Oliver T, Lewis K, Yang Q. Development of necrotizing enterocolitis in premature infants receiving thickened feeds using SimplyThick®. J Perinatol. 2012;32(2):150.PubMedCrossRef
45.
go back to reference Stokes JR, Boehm MW, Baier SK. Oral processing, texture and mouthfeel: from rheology to tribology and beyond. Curr Opin Colloid Interface Sci. 2013;18(4):349–59.CrossRef Stokes JR, Boehm MW, Baier SK. Oral processing, texture and mouthfeel: from rheology to tribology and beyond. Curr Opin Colloid Interface Sci. 2013;18(4):349–59.CrossRef
46.
go back to reference Matta Z, Chambers E IV, Garcia JM, Helverson JM. Sensory characteristics of beverages prepared with commercial thickeners used for dysphagia diets. J Am Diet Assoc. 2006;106(7):1049–54.PubMedCrossRef Matta Z, Chambers E IV, Garcia JM, Helverson JM. Sensory characteristics of beverages prepared with commercial thickeners used for dysphagia diets. J Am Diet Assoc. 2006;106(7):1049–54.PubMedCrossRef
47.
go back to reference Vivanti A, Campbell K, Suter MS, Hannan-Jones M, Hulcombe J. Contributions of thickened fluids, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet. 2009;22:148–55.PubMedCrossRef Vivanti A, Campbell K, Suter MS, Hannan-Jones M, Hulcombe J. Contributions of thickened fluids, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet. 2009;22:148–55.PubMedCrossRef
48.
go back to reference Wolter NE, Hernandez K, Irace AL, Davidson K, Perez JA, Larson K, Rahbar R. A systematic process for weaning children with aspiration from thickened fluids. JAMA Otolaryngol Head Neck Surg. 2018;144(1):51–6.PubMed Wolter NE, Hernandez K, Irace AL, Davidson K, Perez JA, Larson K, Rahbar R. A systematic process for weaning children with aspiration from thickened fluids. JAMA Otolaryngol Head Neck Surg. 2018;144(1):51–6.PubMed
49.
go back to reference Cichero JA, Nicholson TM, September C. Thickened milk for the management of feeding and swallowing issues in infants: a call for interdisciplinary professional guidelines. J Hum Lact. 2013;29(2):132–5.PubMedCrossRef Cichero JA, Nicholson TM, September C. Thickened milk for the management of feeding and swallowing issues in infants: a call for interdisciplinary professional guidelines. J Hum Lact. 2013;29(2):132–5.PubMedCrossRef
Metadata
Title
Thickened Liquids Using Pureed Foods for Children with Dysphagia: IDDSI and Rheology Measurements
Authors
Laura Brooks
Jianshan Liao
Jaclyn Ford
Sarah Harmon
Victor Breedveld
Publication date
01-06-2022
Publisher
Springer US
Published in
Dysphagia / Issue 3/2022
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-021-10308-1

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