Liquid thickeners are often used in infant feeding to address difficulties like frequent regurgitation or swallowing issues. Products like Thick-It were originally designed for adults with dysphagia, making it paramount for parents to understand the specific risks for infants. The decision to thicken an infant’s feed should never be casual, as a baby’s developing digestive system reacts differently to these substances. This article explores the components of conventional thickeners, details potential health consequences, and outlines medically supervised conditions and alternatives for managing feeding challenges.
The Composition of Thickening Agents
Thick-It Original is a widely available commercial thickener primarily composed of modified cornstarch and maltodextrin. These starches absorb water, causing the granules to swell and increase the liquid’s viscosity. This process changes a thin liquid into a nectar- or honey-like consistency to facilitate safer swallowing.
Starch-based thickeners differ from newer formulas that rely on natural gums, such as xanthan gum or carob bean gum. Gum-based products achieve the same effect but have a different molecular structure and digestion profile. The base composition of the thickener determines how the infant’s immature gut will process it, which directly relates to the potential for adverse health effects.
Potential Digestive and Health Risks for Infants
The primary and most severe risk associated with thickeners, particularly in premature or medically vulnerable infants, is Necrotizing Enterocolitis (NEC). NEC is a life-threatening intestinal disease where bowel tissue becomes inflamed and dies. Although NEC has been strongly linked to specific xanthan gum-based thickeners in preterm infants, this concern extends to all thickeners, including cornstarch-based products.
Starch thickeners pose a risk because infants under nine months old have low levels of the enzyme amylase, limiting their ability to digest cornstarch. Undigested starch residue travels through the immature gut, providing a food source for harmful bacteria. This can contribute to the intestinal inflammation characterizing NEC. Therefore, cornstarch-based thickeners like Thick-It are not routinely recommended for infants.
Thickening feeds also carries secondary concerns related to nutrition and hydration. Adding significant amounts of starch increases the feed’s carbohydrate content, potentially leading to excessive weight gain if not monitored. Increased viscosity can slow gastric emptying and cause a feeling of fullness, which may result in reduced overall fluid intake, dehydration, or constipation.
Thickeners can also present an aspiration risk themselves. If the feed is not mixed precisely, or if the infant’s esophageal function is immature, the thicker fluid is more difficult to move through the esophagus. This increases the risk of aspirating the heavy, viscous fluid, which can be more damaging to the lungs than aspirating a thin liquid.
When Medical Professionals Recommend Thickening
The use of any feed thickener must occur under the strict guidance of a pediatric healthcare team, such as a pediatrician, gastroenterologist, or speech-language pathologist. Thickening is a medical intervention, not a routine feeding modification. It is typically reserved for infants with confirmed conditions, such as severe, persistent gastroesophageal reflux (GERD) that has failed to respond to positional and feeding changes.
The most common indication for thickening is a diagnosis of oropharyngeal dysphagia, or difficulty swallowing, which puts the infant at risk for aspiration. This diagnosis is often confirmed through objective measures like a video fluoroscopic swallow study (VFSS). Thickening is viewed as a last-resort measure when the risk of aspiration outweighs the potential risks associated with the thickener itself.
Regulatory bodies strongly caution against the routine use of non-prescription, starch-based thickeners in young infants, especially premature infants, for whom many thickeners are strictly contraindicated. If thickening is necessary, the preparation must be precise. The thickener’s effect can vary dramatically depending on the base liquid; for example, the amylase in breast milk can break down starch thickeners, reducing their viscosity over time.
Alternative Methods for Managing Feeding Difficulties
Before resorting to thickeners, medical professionals encourage non-thickening strategies to manage reflux and swallowing difficulties. Simple behavioral and positional modifications are often the first line of defense.
Behavioral and Positional Strategies
- Offer smaller feeding volumes at more frequent intervals to prevent the stomach from becoming overly full.
- Maintain the infant in an upright position during and for twenty to thirty minutes after a feeding.
- Employ paced bottle feeding techniques to deliberately slow the flow of milk, allowing the infant to better coordinate the suck-swallow-breathe pattern.
- Use proper burping techniques and ensure a calm feeding environment to reduce air ingestion and subsequent reflux symptoms.
When a thickener is medically necessary, healthcare providers often prefer alternatives to conventional starch-based products. Some thickeners are specifically formulated for infants using ingredients like carob bean gum, which has a lower risk profile for certain complications in full-term infants. These products are prescribed and monitored closely to ensure appropriate consistency and to watch for adverse effects, such as changes in stool consistency or weight gain.