Thickening infant feeds involves adding a substance to breast milk or formula to change its viscosity. This practice should only be undertaken after a recommendation from a pediatrician, gastroenterologist, or feeding specialist. Professional guidance is necessary because the safety and effectiveness of a thickener depend entirely on the infant’s age, underlying condition, and the type of thickening agent used.
Medical Indications for Liquid Thickening
Healthcare providers recommend thickening an infant’s feeds primarily to address two distinct medical concerns: gastroesophageal reflux (GERD) and oropharyngeal dysphagia, which involves the risk of aspiration. GERD causes infants to frequently spit up milk because the liquid contents of the stomach flow back up into the esophagus. Thickening the feed is a first-line approach in current guidelines, as it increases the density of the stomach contents, making them harder to regurgitate and reducing the frequency of spit-up episodes.
The second, and often more serious, indication is dysphagia, or difficulty swallowing, which can lead to the aspiration of liquid into the lungs. When thin liquids are swallowed too quickly or without proper coordination, they can enter the airway, potentially causing respiratory complications like pneumonia. By increasing the viscosity of the feed, the liquid moves more slowly through the mouth and throat. This allows the infant more time to coordinate the suck-swallow-breathe pattern, improving oral-motor control and reducing the risk of the liquid entering the trachea.
While moderately effective for reflux, thickening is a primary method for managing aspiration risk. The decision to thicken feeds is typically made after a thorough evaluation by a feeding team.
Safety Concerns Associated with Starch-Based Thickeners
Products like Thick-It are starch-based thickeners, and their use carries specific safety concerns, particularly for premature or very young infants. The most significant historical concern is the association with Necrotizing Enterocolitis (NEC), a severe intestinal disease. While the most publicized cases of NEC were linked to a xanthan gum thickener, the general use of commercial thickeners is considered high-risk for vulnerable infants.
Starch thickeners present a digestive load that the immature digestive system of a young infant may not handle effectively. Infants, especially those under six months, produce lower levels of the enzyme amylase, which is necessary to break down starch molecules. When large amounts of undigested starch reach the lower intestines, it can alter the gut flora and fluid balance, potentially leading to gastrointestinal distress, constipation, or osmotic diarrhea.
Starch-based thickening can also unintentionally alter the nutritional profile of the feed. Adding thickener displaces a portion of the milk or formula, which changes the overall concentration of calories and nutrients. This change can affect the infant’s hydration status or lead to over- or under-nutrition. For these reasons, many guidelines recommend avoiding starch-based thickeners in preterm infants and reserving them for older, healthy, term-born babies.
Overview of Alternative Thickening Methods
Pediatric specialists often utilize several alternatives to achieve the necessary viscosity. One traditional method involves using infant rice cereal, which is used in healthy, term infants older than four to six months. Rice cereal effectively thickens formula, but it significantly increases the carbohydrate and caloric density of the feed.
Another common approach is the use of pre-thickened anti-regurgitant formulas. These commercial formulas are formulated for better viscosity control and nutritional balance. However, even these formulas may be associated with side effects such as increased constipation.
Gum-based thickeners, such as those made from xanthan gum or carob bean gum, represent a newer class of products. These thickeners do not rely on the infant’s immature amylase enzyme for digestion, making them effective for thickening breast milk. While some gum-based thickeners have been historically linked to serious adverse events like NEC in premature infants, current products like Gelmix are often approved for use in infants after they reach 42 weeks post-conception.
Guidelines for Safe Administration and Monitoring
Thickening an infant’s feed must always be done under the direct supervision and prescription of a healthcare provider. The type and amount of thickener must be precisely matched to the child’s specific medical need and age. Mixing instructions must be followed exactly, as using too much thickener can create a choking hazard.
Parents must closely monitor the infant for changes after beginning thickened feeds, including hydration, weight gain, and bowel habits. Constipation is a common side effect, and any significant change in stool frequency or consistency should be reported to the doctor immediately. A specialized nipple is necessary to ensure the infant can feed safely and efficiently. The flow rate of the thickened liquid through the nipple should be tested to confirm the correct consistency.