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Feeding a Child With a Laryngeal Cleft
By Caetyn Groner, MS, CCC-SLP
Thickening Agents
It’s very important for parents to work with their child’s SLP, dietician, and physicians to determine which thickening agent is most appropriate to ensure safe swallowing and meet nutritional needs. The SLP should consult with the entire medical team and consider the thickening agent’s impact on:
viscosity of specific liquids
nutritional status
overall health
calories
ingredients
allergies/intolerances
contraindications
constipation/loose stool
specific nutrients (iron, for example)
exposure to heavy metals (arsenic, for example)
Commercial Thickeners
There are a variety of commercially-available thickening agents. The SLP should recommend specific brands based on the child’s age, allergies and dietary restrictions, insurance coverage, and personal preferences.
Special caution should be taken for infants of any age with the use of commercial, gum-based thickeners due to a risk of developing serious intestinal disease.
Age-Based Thickeners
<1 year
*Approved for use in infants. Consult your medical team for specific recommendations. Do not use GelMix for infants under six pounds or those born preterm and currently under a corrected age of two weeks (42 weeks postmenstrual age).
1 year+
3 years+
12 years+
*SimplyThick EasyMix could be an option for thickening liquids for children under the age of 12, if recommended and monitored by a physician. Check with your child’s medical team to see if it would be safe, based on the product’s specific ingredients and your child’s medical history.
Which Thickener?
The decision on which brand of thickener to use should be made through discussions between the parent and the child’s medical team. This list is not exhaustive and other brands are available. LCN does not recommend any specific brand of thickener.
Gum-Based vs. Starch-Based Thickeners
Thickeners are typically made with either gum or starch ingredients. Liquids thickened with gums vs. starches will have differences in their taste, texture, and viscosity. Starch thickeners tend to get thicker over time or in cold liquids, so you will likely need to experiment with different amounts of thickener to achieve the desired results. Other variables, such as the liquid temperature and the presence of saliva, may affect the end result.
Gum-Based:
Gum types include xanthan, carob bean, guar, and gellan.
Starch-Based:
Starch types include tapioca, corn, and maltodextrin.
Maltodextrin can be derived from tapioca, rice, corn, wheat, or potato starch. If your child has severe allergies to any of those foods, it may be beneficial to discuss with their allergy team and contact the manufacturer of the product.
Homemade Thickeners
Homemade thickeners such as purees and baby cereals (rice, oatmeal, etc.) can be used to thicken liquids. However, they need to be closely measured for the appropriate IDSSI level and the behavior of the thickening agent with factors such as heat, cold, and time. Liquids thickened with purees or cereals may increase or decrease in thickness over time, and may separate with temperature changes. Be very aware of the thickness when you begin using homemade thickeners, noting how they affect the various liquids your child drinks.
Special Considerations
Breast Milk:
There are special considerations when thickening human milk. Amylase in human milk breaks down starches, and there is 25 times more amylase in human milk than formula. This means cereals, such as oatmeal and rice, are believed to break down to a greater degree in human milk. GelMix, a gum-based thickener, is formulated specifically to thicken human milk and may be more reliable than cereal.
Amino Acid/Elemental Formulas:
These can be particularly difficult to thicken and are usually recommended for children with severe food allergies or gastrointestinal issues. Extra caution should be taken when choosing a thickener for these children. In the author’s experience, thickening water first, then adding the formula to the thickened water, yielded the most accurate results in consistent thickness. GelMix and Purathick are allergy-friendly and allergy-aware commercial thickeners.