Feeding a Child With a Laryngeal Cleft

By Caetyn Groner, MS, CCC-SLP

Thickened Liquids

Thickening

Advantages: 

  • Allows the child to safely continue developing their feeding and swallowing skills.

  • Serves as an alternative to a feeding tube for some children.

  • May improve reflux symptoms.

Disadvantages: 

  • Adds ingredients to the child’s diet that may not be preferred.

  • May be needed long term.

  • The child may not like the taste, which could lead to dehydration or constipation.

  • Can be constipating for some children.

If your child cannot drink thin liquids without penetration or aspiration, you will likely be told they need their liquids thickened. Thickening liquids may make eating and drinking by mouth safer for your child. Thickening slows the flow of liquids, making it easier for the child to control and reducing penetration and aspiration. However, thickening liquids does not prevent a child from aspirating on their own secretions, such as saliva and reflux.

International Dysphagia Diet Standardisation Initiative (IDDSI) Thickness Categories

In 2015, IDDSI released global standards to communicate drink thicknesses and food textures for children and adults. Before that framework, thickness recommendations for liquids were communicated as nectar, honey, and pudding consistencies. Today, IDSSI’s thickness standards are:

Liquids:

  • 0: thin

  • 1: slightly thick

  • 2: mildly thick

  • 3: moderately thick

  • 4: extremely thick

Solids:

  • 3: liquidized

  • 4: pureed

  • 5: minced and moist

  • 6: soft and bite-sized

  • 7: easy to chew

“Examples of thin liquid are water, milk, or juice. Thin liquids drip very quickly. So during a swallow, they move very quickly. Safely drinking thin liquids from any vessel is often the ultimate goal of repairing a laryngeal cleft.”

Your SLP will tell you which IDDSI liquid and solid consistencies are safe for your child. They will also advise which compensatory strategies may help make a certain consistency safe if implemented with every swallow. 

In order to ensure you are thickening liquids appropriately at home, IDSSI gives instructions on testing the thickness of your child’s liquids: IDDSI Flow Test Instructions

Thickener Weaning Process

Your child’s team will determine when it is appropriate to gradually reduce thickeners from your child’s liquids. The initiation of this weaning process usually occurs based on therapy goals, length of intervention, surgical procedures, and the presence of other medical conditions. The process should be gradual, systematic, and guided by your child’s feeding therapist. Some factors to be considered during the process include surgical interventions, respiratory health, symptoms of aspiration, volume tolerance, etc.

Insurance Coverage

Ask the provider who recommended the thickener to write a prescription for the product so that it may qualify for insurance coverage. This ensures timely arrival of the thickener and helps with the cost. If you have trouble getting insurance coverage, product websites often have information to provide to your DME (durable medical equipment) company to help in the process.