Thicken the contents of each bottle just before feeding. Support and training is key https://doi.org/10.1001/archoto.2010.129. Knowing that patients have improved after a job well done you get personal satisfaction from that and the positive feedback from patients. Among clinical decisions, the recommendation to use thickened liquids to reduce or prevent laryngotracheal aspiration in the management of oropharyngeal dysphagia should be made with extreme caution and within limits. While aspiration may be mitigated with an increase in liquid viscosity, rates of pneumonia and respiratory complications have been shown to increase with the use of thickened liquids (Logemann et al., 2008; Wotton, 2008). Thickeners, alongside other factors including positioning, use of different eating and drinking vessels, oral hygiene and the possible use of artificial hydration if clinically indicated can be a valuable tool in the treatment of dysphagia. Host Disease, Children at Risk for Self-Harm or Harm to Others: Home Safety Guidelines for Families, Emergency Phone Numbers and Directions to Nationwide Children's, Epinephrine Auto-Injectors for Severe Allergic Reaction (Adrenaclick, Auvi-Q, EpiPen, Symjepi), Exercises: Left Torticollis Positioning for Play, Exercises: Right Torticollis Positioning for Play, Gonorrhea: Expedited Partner Therapy (EPT), Healthy Sleep Habits for Babies and Toddlers, Healthy Sleep Habits for Older Children and Teens, Helping Children Feel Safe in Stressful Times, Hemophilia Joint and Muscle Bleeds PRICE Home Care, Nasogastric Tubes (Insertion and Feeding), Secondhand Smoke and Cystic Fibrosis (CF), Service Animals at Nationwide Children's Hospital, Sweat Chloride Test Collection Guidelines, Temperature: Digital and Glass Thermometers, Tips and Suggestions for Taking Asthma Medicine, Universal Newborn Hearing Screening (UNHS), Adrenocorticotropin (ACTH) Stimulation Test, Creating a Purposeful Auditory Environment, Helping Very Young Children Cope after a Trauma, Protecting Babies and Young Children from Contagious Illnesses Without Masks, Somatic Disease Germline Comparator Sequencing, Speech and Communication Evaluations for Babies with Hearing Loss, Auditory Brainstem Response (ABR) Testing, Auditory Brainstem Response (ABR) with Sedation or Anesthesia, Biofeedback for Constipation and Pelvic Floor Dysfunction, Birth Control: Progestin-Only Contraceptive Pills, Blood Counts: Chemo and Radiation Therapy, Bone Marrow Transplant: Isolation Procedures, Bronchoscopy (Flexible Bronchoscopy and Bronchoalveolar Lavage), Buccal Medicines: Giving Buccal Medicines, Breast Milk for Your Hospitalized Infant: Electric Breast Pump, Burn Prevention: Preschool and School Age, Cardiac Catheterization: Care at Home (Adult), Cardiac Catheterization - Care at Home (Pediatric), Cardiopulmonary Resuscitation CPR For Children Who Have Gone Through Puberty. A., Kosek, S., Dikeman, K., Kazandjian, M., Gramigna, G. D., Lundy, D., McGarvey-Toler, S., & Miller Gardner, P. J. Nashville, Tennessee 37221 www.sasspllc.com, When you prepare the drink with infant cereal for the flow test, mix only 1 ounce of drink or formula. thickened liquids dysphagia swallowing geripal problems There are many different thickeners available, including those produced by Nestl Health Science. Ashford, J. R. (2005, March). Due to the above symptoms, dysphagia has physical and emotional costs to the patient, as well as economic implications for healthcare systems. By submitting this form, you acknowledge that the information you provide will be transferred to MailChimp for processing in accordance with their Privacy notice and Terms, and to Salesforce Marketing Cloud in accordance with their Privacy notice and Terms. Rather than a one-size-fits-all solution, thickeners are a useful tool as part of a broader approach. European e-Journal of Clinical Nutrition and Metabolism,e47-e53. Do not use artificial (fake) thickeners unless your child is over 12 months of age corrected. It will open today at 3:00PM.*. So, their use requires a consistent, defined approach to ensure that there is interdisciplinary working between SLTs, dietitians, doctors, nursing staff and the patient. Stroke, 37(10), 26072612. Available at: https://researchoutreach.org/articles/thickeners-the-evidence-for-their-appropriate-use-in-dysphagia-management/ (Accessed YYYY/MM/DD). Dysphagia can have profound impacts on social and psychological aspects of a patients life, particularly when it comes to fear of choking. We advise that any liquid thickened with infant cereal be flow-tested before feeding to make sure it is the right consistency. Compassion. How important do you think collaboration with industry is to the speech therapy profession? If you have questions about corrected age, ask your childs health care provider. Theres the trinity of industry, research and the profession on the ground as well, of course, as patient groups and patient feedback.
The formula will keep getting thicker as it sits. Call Michelle Skelley at 615-306-3693. cup dysphagia lma teleflex Foley et al (2008) found that using a combination of texture-modified diet, thickened fluids and intensive support from speech and language therapists resulted in reduced risk of aspiration for the first seven days after a stroke. The Lancet. Follow the manufacturers thickening instructions on the can or packet of thickener. Yet, decades of research consistently demonstrate that aspiration alone will not result in the development of pneumonia (Langmore et al., 1998; Feinberg, Knebl, & Tully, 1996; Ashford, 2005). She treats adult clients and provides dysphagia consultancy to business. Decisions for the proper and safe use of thickened liquids to reduce aspiration potential must be made in the context of (1) potential effectiveness determined from instrumental assessments (VFSS or FEES), (2) the presence of and severity of co-morbidities such as documented dehydration, renal disease, respiratory infection and disease, nervous system impairment, reflux and gastroparesis, and potentially how thickened liquids could impact these conditions, (3) potential medication alterations and effectiveness, and (4) the potential impact on the patients quality of life. Whether its a patient or a peer, Im happy to question and learn new things. Your child may need a different bottle nipple to allow the thickened liquids to get through. The concern around inhaling food or drink is that aspiration pneumonia may develop as a result. Some children have trouble swallowing. Your email address will not be published. Acute and communitysettings There are also frequent safety concerns relating to dysphagia, such as the risk of aspiration (food or fluid entering the lungs). https://doi.org/10.1152/jappl.1980.49.4.715, Nissen, L.M., Haywood, A., & Steadman, K.J. https://doi.org/10.1044/1092-4388(2008/013), Manrique, Y. J., Sparkes, A. M., Cichero, J. Drug development and industrial pharmacy, 42(9), 15371544. Thickening liquids is thought to slow the flow rate of the liquid, allowing more time for airway closure and reducing aspiration risk (Cichero, 2013). The Importance of Having a Relationship With Your Child's Pediatrician, Questions to Ask When Choosing a Pediatrician, Attention Deficit Hyperactivity Disorder (ADHD), Ear, Nose & Throat (Otolaryngology) Services, Gastroenterology, Hepatology & Nutrition, Hematology, Oncology & Blood and Marrow Transplant, Preparing for a Primary Care or Clinic Visit, 24 Hour Urine Specimen Collection Guidelines, Behavior Support: Catching Your Child Being Good, Behavior Support: Preventative Strategies, Behavior Support - Reducing Interruptions, Behavior Support - Using Planned Ignoring at Home, Bone Marrow Transplant Acute Graft vs. https://www.sasspllc.com/three-pillars-pneumonia/, https://doi.org/10.1016/j.clnu.2007.08.006, https://doi.org/10.1161/01.STR.0000177529.86868.8d, https://doi.org/10.1097/MOO.0000000000000622, https://doi.org/10.1097/00005537-200204000-00001, https://doi.org/10.1007/s00455-014-9578-x, https://doi.org/10.1007/s00455-018-09974-5, https://researchoutreach.org/articles/thickeners-the-evidence-for-their-appropriate-use-in-dysphagia-management/, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, Consciousness and Quantum Mechanics wherein Plancks constant becomes a variable, Diversity, Equity, Inclusion & Sustainable Practice statement.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. T: +44 1453 827 934 Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?. This is crucial to changing the culture around the use of thickeners, ensuring that it is not seen as the easy option, but is delivered by qualified professionals who understand the influence that thickener can have on gastric emptying times and other variables. Advanced technologies. To make sure products are thickened correctly, the simple test shown below can be used (Picture 1). Check the nipple during the feeding to make sure it is not clogged with cereal. If information is presented to the patient in full, then they can judge the balance between risk and benefit of a modified diet for themselves. This helps protect the airway. liquids thicken thickening dysphagia fluids types clear resource aspiration As speech and language therapist Sandra Robinson points out, industry innovation can lead to direct patient benefits: the recent move towards using gum-based thickener rather than starch-based thickener was a really useful change for our patients, because it meant that the thickener looked nicer, had an improved taste, and was safer one of the most important aspects. How can we bring that ultimately to the patients benefit, sooner rather than later? Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology, 49(4), 715721. (2016). (2009). If you have questions, talk to your childs health care provider. Altman, K. W., Yu, G. P., & Schaefer, S. D. (2010). A holistic approach Thickened liquids also carry an innate risk of dehydration due to a variety of factors: patients are typically offered fewer thickened liquids throughout the day, there is a reduced desire to drink thickened liquids, and they cause an increased feeling of satiety (Cichero, 2013). Access resources for you to use during your baby's hospital stay and at home. As care home manager Jemma Robinson explains, preparing thickened drinks incorrectly can be just as dangerous as not having the thickener at all. If your child has dysphagia, you may need to thicken the liquids they drink. I think it takes industry to innovate and take things forward, because most of the SLT profession work in the NHS.
https://doi.org/10.1007/BF00417899, Langmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., & Loesche, W. J. Share: You can copy and redistribute the material in any medium or format, Your email address will not be published. Effect of hydration state of circulatory and thermal regulations. John@sasspllc.com, 122 Plantation Court But we should really aim for it to be a temporary measure. For some patients, though, she recognises it may be a longer-term solution. In addition, there are clear benefits to using just one thickener within a local area, as this means that everyone is fully safety trained and competent with one particular product, removing the need for multiple pathways and safety briefings for different products. Child Care and Illness: Should Your Child Stay Home? Respiratory medicine, 2(3), 238246. If you would like to schedule an appointment with one of our nationally ranked specialists or Primary Care physicians please click or call 800-881-7385. A review of the literature on dehydration in the institutionalized elderly. Ill take negative feedback. Im happy to have that, just as Im happy to unlearn. Julie Cichero, co-chair of the IDDSI framework, reports that in the UK, the annual cost of chest infections requiring hospital admission with routine care is around 1.8 times more expensive than chest infections requiring hospital admission with treatment from a speech and language therapist (Cichero, 2019). Additionally, consultation with a pharmacist would be warranted to determine if thickened liquids might interfere with medication absorption. Surprisingly, the possibility of reducing aspiration appears to trump all other concerns. Archives of otolaryngology--head & neck surgery, 136(8), 784789. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded in 2013 to provide consistent and clear terminology around modified textures of food and fluids. https://doi.org/10.1016/S2213-2600(14)70028-1, Feinberg, M. J., Knebl, J., & Tully, J.
Different patients will make different choices depending on their level of concern but for some patients, thickeners can empower them to manage their own health conditions. (2003). (2014). A., Cai, C., Zielinski, A., Danish, M., & Berman, J. Nutrition Journal, 12, 54. https://doi.org/10.1186/1475-2891-12-54, Dickson, R. P., Erb-Downward, J. R., & Huffnagle, G. B. Do you know what? The latter could even increase risk of malnutrition and dehydration if a patient avoids eating and drinking. A. In these cases, thickener can reduce the fear of choking, as well as the actual choking, pain and distress, and that might be true of somebody for a significant period of their life or during end-of-life care.. Below are the instructions for thickening with infant cereal if your child is under 12 months corrected age for the following levels: Level 2 1 -2 tsp cereal/oz formula, Level 1 1 -2 tsp cereal/oz formula, Level 3 2 -3 tsp cereal/oz formula, Level 1 1 -2 tsp cereal/oz formula, Level 2 1 -2 tsp cereal/oz formula, Level 2 2 -2 tsp cereal/oz formula, Level 1 1 -1 tsp/oz infant cereal, Level 2 1 -2 tsp/oz infant cereal, Level 3 2 -2 tsp cereal/oz formula, Level 1 1 -1 tsp cereal/oz formula, Level 3 2 -2 tsp cereal/oz formula, Level 2 1 -2 tsp cereal/oz formula, Level 2 1 -2 tsp cereal/oz formula. This means an increase in the cost of their admission and an increased likelihood of experiencing complications secondary to prolonged hospital stay, such as hospital acquired infections. GL10 3FA A., Gensler, G., Robbins, J., Lindblad, A. S., Brandt, D., Hind, J. Can You Trust Health Information on the Web? Below you can select how youd like us to interact with you and well keep you updated with our latest content. If your child is under the age of 12 months, it is recommended that you use infant cereal to thicken liquids. Perspectives in Swallowing and its Disorders (Dysphagia), 10-15. https://doi.org/10/1044/sasd14.1.10, Begum, M.N. Just as weve noticed that industry has moved on, lets also move on. One of the most common concerns with dysphagia is that food or fluids go down the wrong way, potentially entering the lungs rather than the stomach. School and Illness: Should Your Child Stay Home? Michelle@sasspllc.com, Education Services? To further the existing knowledge base, clinically meaningful endpoints must be considered when undertaking clinical trials around thickeners, and further research and collaboration between healthcare professionals, patients and other stakeholders is crucial.
Its really important that were working ever more closely together. Thickened Liquids: Considerations for Recommendation after FEES. Our Global Patient Services team is here to help international and out-of-area families every step of the way. Sandra Robinson agrees with this approach: Thickener can be really useful while a patient also follows therapy, diet adaptation, and undergoes some possible spontaneous recovery from something like stroke. Its the whole point. This is called dysphagia (dis-FAY-geh-ah). The aim is to reduce the risk of aspiration pneumonia by reducing the risk of fluid inhalation, thus making eating and drinking much safer for patients, as well as improving their quality of life. Therefore, multidisciplinary working between healthcare professionals is key to ensure that thickeners are used appropriately, especially where there may be a tendency to overthicken (Garcia and Chambers, 2019). You can get artificial thickeners at your local pharmacy. Would you like to learn more about our services? diet dysphagia menu asha buyers guide soft speech foods level sample medical recipes buyersguide language If you use infant cereal flakes, such as Gerber, run a can or a rolling pin over the plastic bag to crush the cereal or use a blender to pulverize the cereal more. Three Pillars of Pneumonia From Aspiration, Portable Endoscope Disinfectant System (PEDS), https://doi.org/10.1016/S2213-2600(14)70028-1, https://doi.org/10.1016/j.mayocp.2018.03.011, https://doi.org/10.1044/1092-4388(2008/013), https://doi.org/10.3109/03639045.2016.1151033, https://doi.org/10.1152/jappl.1980.49.4.715, https://doi.org/10.1002/j.2055-2335.2009.tb00436.x, https://doi.org/10.1186/s12877-018-0839-7, https://doi.org/10.1161/01.STR.0000240409.68739.2b. Stroke propagates bacterial aspiration to pneumonia in a model of cerebral ischemia. This product can be used if your child is over 12 months of age, corrected. While aspiration may lead to pneumonia, the systemic effects of dehydration can be devastatingespecially with medically fragile, chronically ill, or geriatric populations. (2008). The first step in creating this common taxonomy was to examine the existing data. There are other products on the market to thicken liquids. Of primary concern is the delaying effects for those medications that have narrow windows of required therapeutic levels, such as anti-convulsive medications and blood-thinners (OKeeffe, 2018; Nissen, Haywood, & Steadman, 2009). Journal of Pharmacy Practice and Research, 39(2), 129-134. https://doi.org/10.1002/j.2055-2335.2009.tb00436.x, OKeeffe S. T. (2018). While much evidence exists to support the use of thickeners in dysphagia, multiple parties are often involved when it comes to the actual application of thickeners. (1998). Dysphagia, 13(2), 6981. This is especially important when we think about the people who are administering thickener or blending a meal; it is often a busy carer or nurse who requires clear, specific guidance to prepare appropriate food and fluids. In addition to powder-based thickeners which are added to fluids to achieve the correct consistency, it is possible to use ready-made nutritional supplements which are pre-thickened. In acute settings, early identification and management of dysphagia is crucial and can reduce the risk of pneumonia three-fold.
Children with dysphagia need to have their food and drink changed so they can safely eat and drink. Do not use infant cereal in breast milk. You can also order the thickener online or by phone. Use a BD 10mL slip tip syringe (syringe box reference number - 303134), Images Source: (c) The International Dysphagia Diet Standardisation Initiative 2016. This product should not be used for any child under the age of 12 years with a history of necrotizing enterocolitis (NEC). Indeed, in acute settings, early identification and management of dysphagia is crucial and can reduce the risk of pneumonia three-fold (Hinchey et al, 2005). (2006). This gives your child extra time to control the liquid while swallowing and keep it out of the lungs. One approach often used by SLTs is the addition of thickening agents to normal fluids to make them more viscous, and therefore easier for patients to swallow. By clicking below to submit this form, you acknowledge that the information you provide will be transferred to MailChimp for processing in accordance with their Privacy Policy and Terms. Expertise. swallow bedside checklist dysphagia speech therapy weebly pdf tools language adult oral handout motor goodies There is evidence to suggest that people with severe dysphagia who are worried about drinking thin fluids may appreciate the greater control over aspiration risk that thickened fluids allow (Schindler & Kelly, 2002). Emotional impacts Sandra Robinson is an independent speech and language therapist. Dehydration can lead to renal failure, constipation, urinary tract infections, hypotension, confusion/delirium, poor recovery from illness, and respiratory infections (Cichero, 2013; Wotton, 2008; Nadel, 1980; Begum & Johnson, 2010; Mukand, Cai, ZielinskiBerman, 2003). The effects of dehydration on rehabilitation outcomes of elderly orthopedic patients. It can be a comfort for some people who choke or have prolonged coughing bouts that are thoroughly distressing and uncomfortable, maybe even painful, on regular drinks. Access ANCHOR, the intranet for Nationwide Childrens employees. United Kingdom As research has shown, there is a place for thickeners in dysphagia, but only if used correctly, monitored, reviewed and used in conjunction with other approaches such as swallowing rehabilitation and use of appropriate drinking vessels (Lippert et al, 2019). https://doi.org/10.1161/01.STR.0000240409.68739.2b, Wotton, K., Crannitch, K., & Munt, R. (2008). Call John Ashford at 615-426-5505. Lets find new ways of working together and help give patients exactly what they want. Research takes time and its companies like Nestl Health Science who can really help bring things along and say to the profession, Look, this is what we can deliver. Patient safety is therefore paramount when managing dysphagia. We recommend that you discuss any other product not listed above with your health care provider to determine if the product is a good choice for your child.
Catheterization: Self-Clean Intermittent - Female, Cardiopulmonary Resuscitation (CPR) for Children 1 to Puberty, Catheterization - Self-Clean Intermittent - Male, Cardiopulmonary Resuscitation (CPR) for Infants, Chest Physiotherapy - Infants Newborn to 12 Months. & Johnson, S. (2010). Even with acute CVA, it has been demonstrated that aspiration alone is insufficient for the development of pneumonia; rather, it is the activation of the sympathetic nervous system that inhibits the immune response to pathogens in the lungs (Prass, et al., 2006). I think, as a profession, we need to be more open to that and to be saying, Yes, we will unlearn some of the old ways. She says, Thickener means that residents can take their usual fluids, it reduces the risk of aspiration which can cause complications, or it means they do not need to have any other interventions like IV fluids: they can live a normal life. It is not only nursing home residents whose lives are impacted; over half of head and neck cancer patients report reduced quality of life due to dysphagia (Garcia-Peris et al, 2007). A systematic review, which summarised 36 high quality studies, was conducted during the creation of the framework (Steele et al, 2015) and the results showed that thicker liquids reduce the risk of aspiration but can increase the risk of post-swallow residue in the pharynx. Speak with your childs doctor or registered dietitian if you have questions about how these changes may affect the amount of liquid and how many calories your child is getting. If you have any questions about how we handle your data, please review our privacy notice. Tracheostomy: How to Protect the Child with a Trach Tube, Tracheostomy Tube Care With a Reusable Inner Cannula, Tracheostomy: What It Is and When It Is Needed, Transmission-Based Precautions (Isolation): Antibiotic-Resistant Organisms, U-Bag Urine Collection Guidelines for Males and Females, Well Baby Visits: Twelve Months (One Year), The International Dysphagia Diet Standardisation Initiative 2016, Partners For Kids: Pediatric Accountable Care, The location is currently closed. Indeed, the pathogenesis of pneumonia from aspiration of food and liquid remains poorly understood, and misconceptions about the development of nosocomial pneumonia still abound (Dickson, Erb-Downward, & Huffnagle, 2014). 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Moving away from an acute setting, care home manager Jemma Robinson feels thickened fluids offer many benefits to her residents, particularly as safety is a priority in this vulnerable population. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. You may need to roll the nipple with your fingers or clean out the clog. In summation, thickened liquids carry multiple risks that could negatively impact the overall health of patients, and the recommendation to consume thickened liquids should be made with extreme caution. Predictors of aspiration pneumonia: how important is dysphagia?. Used correctly, thickeners have multiple benefits for dysphagic patients. New guides have been put in place by the International Dysphagia Diet Standardisation Initiative (IDDSI) to help with your childs diet. According to Ashford (2005), there are three pillars of pneumonia: health status, oral health status and swallow function. This product can also be used with breastmilk if your child is over 12 months of age corrected. If this occurs, the patient is often seen to cough and choke when eating or drinking.