Prevalence, risk factors and strategies to prevent dehydration in older adults. There are other products on the market to thicken liquids. Learn more about the symptoms of Coronavirus (COVID-19), how you can protect your family, and how Nationwide Children's Hospital is preparing. This is something weve developed. We use MailChimp and Salesforce Marketing Cloud as our marketing automation platforms. 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.
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. Mayo Clinic Proceedings, 93(6), 752762. Some children have trouble swallowing. Would you like to learn more about our services? Common symptoms of dysphagia can include dribbling, coughing or choking, pouching or storing food in the mouth, and avoiding mealtimes. 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. This product can be used if your child is over 12 months of age, corrected. How important do you think collaboration with industry is to the speech therapy profession? John@sasspllc.com, 122 Plantation Court A., Kosek, S., Dikeman, K., Kazandjian, M., Gramigna, G. D., Lundy, D., McGarvey-Toler, S., & Miller Gardner, P. J. Suite 20 Westend Office Suites The NHS moves at a very, very slow pace, as do a lot of higher education institutes. 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). This is called dysphagia (dis-FAY-geh-ah). Solid medication dosage form modification at the bedside and in the pharmacy of Queensland Hospitals. Use a BD 10mL slip tip syringe (syringe box reference number - 303134), Images Source: (c) The International Dysphagia Diet Standardisation Initiative 2016. Always follow the manufacturers packaging instructions for thickening. The latter could even increase risk of malnutrition and dehydration if a patient avoids eating and drinking. BMC Geriatrics, 18(1), 167. https://doi.org/10.1186/s12877-018-0839-7, Prass, K., Braun, J. S., Dirnagl, U., Meisel, C., & Meisel, A. Lets find new ways of working together and help give patients exactly what they want. 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.
Can You Trust Health Information on the Web? These results support the use of thickeners in the context of a wider support strategy. 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.. This is where the role of producers in supporting the use of their thickeners is so paramount. 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). https://doi.org/10.1001/archoto.2010.129. https://doi.org/10.1016/S2213-2600(14)70028-1, Feinberg, M. J., Knebl, J., & Tully, J. Stroke, 37(10), 26072612. Stroke propagates bacterial aspiration to pneumonia in a model of cerebral ischemia. 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. While prandial aspiration may result in pneumonia (or may be harmless), aspiration of gastric contents can have dramatic and dire consequencesincluding pneumonitis, bronchospasm, bronchitis, lung fibrosis, and ARDS (Lee & Ryu, 2018). 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. Do not use infant cereal in breast milk. A holistic approach Oral medication delivery in impaired swallowing: thickening liquid medications for safe swallowing alters dissolution characteristics. With increased liquid viscosity, delay in medication dissolution and disintegration in the gut increases (Cichero, 2013, Manrique et al., 2016). 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. 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. The concern around inhaling food or drink is that aspiration pneumonia may develop as a result. Thickeners and thickened liquids meet the requirements of Food for Special Medical Purposes in the EU (Cichero, 2019), highlighting the need to use thickeners under medical supervision. Physical impacts Any treatment option that further slows digestion in these patients is particularly problematic as it could aggravate the underlying conditionplacing the patient at higher risk for aspiration of gastric contents. Hence, they should be recommended only when absolutely necessarythat is, when their use is confirmed by VFSS or FEES to directly improve airway protection significantly over thin liquidsand not as a routine go-to treatment Contraindications for useeven with improved airway protectionwould include chronic dehydration, renal failure, gastroparesis, reflux, and patient inability to intake enough fluids to maintain hydration. While thickeners are widely used, best practice involves using fluids as close to normal as possible. 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. We are able share your email address with third parties (such as Google, Facebook and Twitter) in order to send you promoted content which is tailored to your interests as outlined above. Pneumonia: Factors beyond laryngeal aspiration. A., Gensler, G., Robbins, J., Lindblad, A. S., Brandt, D., Hind, J. Archives of otolaryngology--head & neck surgery, 136(8), 784789. Journal of Speech, Language, and Hearing Research, 51(1), 173183. If you have any questions about how we handle your data, please review our privacy notice. (2014). If you have questions about corrected age, ask your childs health care provider. Share: You can copy and redistribute the material in any medium or format, Your email address will not be published.
Sandra Robinson recommends thinking about the following values when considering the use of thickened fluids; firstly, the patients needs, wishes and preferences, and then how the patient will feel, function and survive if prescribed thickeners. Do you know what? Archives of physical medicine and rehabilitation, 84(1), 5861. The effects of dehydration on rehabilitation outcomes of elderly orthopedic patients. It will open today at 3:00PM.*. There are many different thickeners available, including those produced by Nestl Health Science. If your child is under the age of 12 months, it is recommended that you use infant cereal to thicken liquids. (2008). Where patients feel thickener helps, though, this risk can be managed, for example by encouraging additional swallow movements after each sip. Thickened liquids move more slowly than thin liquids. A review of the literature on dehydration in the institutionalized elderly. You may need to roll the nipple with your fingers or clean out the clog. The first step in creating this common taxonomy was to examine the existing data.
https://doi.org/10.1007/PL00009559, Lee, A. S., & Ryu, J. H. (2018). Overall, there is a role for thickener in managing dysphagia for patients in acute and community settings, whilst being used safely and effectively. HH-IV-105 2013, Revised 2021, Nationwide Childrens Hospital. Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis. 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. As care home manager Jemma Robinson explains, preparing thickened drinks incorrectly can be just as dangerous as not having the thickener at all. 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). Surprisingly, the possibility of reducing aspiration appears to trump all other concerns. Westend 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.
Thank you for expressing interest in joining our mailing list and community. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded in 2013 to provide consistent and clear terminology around modified textures of food and fluids. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?. When you prepare the drink with infant cereal for the flow test, mix only 1 ounce of drink or formula. Effect of hydration state of circulatory and thermal regulations. If your child has dysphagia, you may need to thicken the liquids they drink. Nutrition Journal, 12, 54. https://doi.org/10.1186/1475-2891-12-54, Dickson, R. P., Erb-Downward, J. R., & Huffnagle, G. B. 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). Whether its a patient or a peer, Im happy to question and learn new things. This helps protect the airway.
Dysphagia can be short term, for example while recovering from a stroke, or more long term, for example in dementia or with neurological conditions. 
https://doi.org/10.1016/j.mayocp.2018.03.011, Logemann, J. Stonehouse Acute and communitysettings 2022 SA Swallowing Services, PLLC, Training Course Schedules and Registrations, #5 Pharyngeal/Esophageal Mass-Fibrovascular Polyp, Course Cancellation and Switching Policies, FEES Competency Training Purpose & Objectives, FEES Competency Training Prerequisites & Methods, Typical Competency Training Daily Schedule, Position Statement: COVID-19, FEES, & SASS, GERD Considerations and Oropharyngeal Dysphagia, Use of Thickened Liquids in Dysphagia Management. 2019). https://doi.org/10.1007/BF00417899, Langmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., & Loesche, W. J. 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 gives your child extra time to control the liquid while swallowing and keep it out of the lungs. 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). Multidisciplinary working is key, as is the use of a holistic approach which uses other strategies to improve health and well-being for dysphagic individuals. A further consideration is warranted for patients with reflux and gastroparesis because thickened liquids can delay gastric emptying and slow digestion. Children with dysphagia need to have their food and drink changed so they can safely eat and drink. 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. She promotes innovation and best practice to progress care for individuals with dysphagia. 
Thicken the contents of each bottle just before feeding. Other known risks associated with thickened liquids not discussed previously: decreased quality of life, increased institutional cost to provide thickened liquids, awkward social situations, and silent aspiration. School and Illness: Should Your Child Stay Home? Early identification of dysphagia is key, and SLTs will use a variety of different techniques to assess swallowing impairment, including bedside screening tools, physical assessment and videofluoroscopy (Steele et al.
https://doi.org/10.3109/03639045.2016.1151033, Mukand, J. 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. Just as weve noticed that industry has moved on, lets also move on. 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. Swallowing difficulties (dysphagia), can occur for a number of reasons, including damage to the nervous system, such as a stroke or head injury, or cancer, such as mouth cancer. Nashville, Tennessee 37221 www.sasspllc.com, How can we bring that ultimately to the patients benefit, sooner rather than later? Predictors of aspiration pneumonia: how important is dysphagia?. While the rate of pneumonia associated with prandial aspirationoutside of acute CVAranges from 1-12% (Feinberg, Knebl, & Tully, 1996; Logemann et al., 2008). However, a significant body of literature, spanning at least two decades, demonstrates that prandial aspiration of liquids is insufficient to cause pneumonia without other factors (impaired immune response and poor oral health). 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. Contemporary Nurse, 31(1), 4456. (1996). There is, though, also a chance they are silently inhaling fluid or food, a situation which could only be identified with special investigations such as a video fluoroscopy of the swallow action. You can unsubscribe at any time by contacting us at admin@email.researchoutreach.org. Safety underpins their practice and they are dedicated to providing guidance, training and access to relevant services. (2016). 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. & Johnson, S. (2010). 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. 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. Available at: https://researchoutreach.org/articles/thickeners-the-evidence-for-their-appropriate-use-in-dysphagia-management/ (Accessed YYYY/MM/DD). New guides have been put in place by the International Dysphagia Diet Standardisation Initiative (IDDSI) to help with your childs diet. 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). By selecting any of the topic options below you are consenting to receive email communications from us about these topics. 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). What Should An Instrumental Swallow Study Report Tell You? 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. 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(2003). (2009). Rather than a one-size-fits-all solution, thickeners are a useful tool as part of a broader approach. In acute settings, early identification and management of dysphagia is crucial and can reduce the risk of pneumonia three-fold. 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. (2013). https://doi.org/10.1053/apmr.2003.50064, Nadel, E. R., Fortney, S. M., & Wenger, C. B. For example, patients with dysphagia have a 40% increase in length of hospital stay (Altman, Yu & Schaefer, 2010). 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Below you can select how youd like us to interact with you and well keep you updated with our latest content. E: audience@researchoutreach.org. Use measuring spoons to figure out infant cereal amounts. Thickeners are a useful tool as part of a broader approach. <> I think for the speech therapy profession working with industry is highly necessary. 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 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. Ashford, J. R. (2005, March). https://doi.org/10.5172/conu.673.31.1.44, Clinical Services? Patient safety is therefore paramount when managing dysphagia. The role of Speech and Language Therapists A holistic approach to dysphagia has many benefits: food provides more than just nutrients and plays an important role in the social, emotional and cultural aspects of life. I think it takes industry to innovate and take things forward, because most of the SLT profession work in the NHS. If you have questions, talk to your childs health care provider. Support and training is key So, their use requires a consistent, defined approach to ensure that there is interdisciplinary working between SLTs, dietitians, doctors, nursing staff and the patient. Outside of work, she supports animal rescue charities. Breast milk breaks down the cereal and it does not stay thickened. Nestl Health Science offers support to care homes, other community organisations and individuals with dysphagia, for example through face-to-face or digital safety briefings. Im happy to have that, just as Im happy to unlearn. A., Cai, C., Zielinski, A., Danish, M., & Berman, J. <> I think ultimately, the greatest satisfaction for me is in seeing benefit to patients. For patients with bacterial infections, convulsions, Type 2 Diabetes, angina, hypertension, and heart and blood circulation disorders, thickened liquids have been shown to delay the bioavailability of some medications. Altman, K. W., Yu, G. P., & Schaefer, S. D. (2010). Its really important that were working ever more closely together. Access ANCHOR, the intranet for Nationwide Childrens employees. Once you reach the correct level, mix the rest of the drink or formula that you need using the same amount of cereal for each additional ounce (Picture 2). 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.
Dysphagia, 11(2), 104109. Advanced technologies. This product should not be used for any child under the age of 12 years with a history of necrotizing enterocolitis (NEC). While aspiration may lead to pneumonia, the systemic effects of dehydration can be devastatingespecially with medically fragile, chronically ill, or geriatric populations. They have the ability to reduce aspiration in some patients. If this occurs, the patient is often seen to cough and choke when eating or drinking. 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, 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.
Talk with your childs doctor, speech language pathologist or occupational therapist before you make any changes. Drug development and industrial pharmacy, 42(9), 15371544. Emotional impacts 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. She treats adult clients and provides dysphagia consultancy to business. The formula will keep getting thicker as it sits. Its the whole point. 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). Dysphagia can have profound impacts on social and psychological aspects of a patients life, particularly when it comes to fear of choking. 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. European e-Journal of Clinical Nutrition and Metabolism,e47-e53. (2020). I dont think we can get results without each other. 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).
thickened liquids for dysphagia
