Thickening human milk: the effect of time, temperature, and thickener for infants with dysphagia

Abstract

Abstract Objective The aim of this study was to investigate the effect of time, temperature, and thickening agents on expressed human milk thickened for infants with dysphagia. Thickening agents included oatmeal cereal, commercial thickeners (Gelmix, Purathick), pureed fruits, pureed vegetables, yogurt, and pudding. Methods The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was used to measure the thickness level across samples at various temperatures (40º, 70º, 98.6ºF) and times (0, 5, 10, and 20 minutes). Statistical analysis included one-way ANOVA with Tukey post-hoc test and multiple linear regression. Results Fruit purees mixtures, particularly banana, achieved the thickest mixture at all temperatures and maintained a similar thickness over time. Vegetable puree mixtures were minimally effective at thickening, i.e. between 0–1 ml on IDDSI flow test, with exception of squash at 40ºF only. Commercial thickeners (Gelmix and Purathick) mixtures continued to thicken over time. The yogurt mixture at 40ºF thickened initially and thinned slightly over time. The pudding mixture at 40ºF thickened immediately but quickly became a thin liquid. The oatmeal cereal mixtures thinned or thickened over time depending on the temperature of the human milk (cold thinned over time, warm thickened over time). Conclusions Time, temperature, and thickening agents have a significant impact on the thickness level when added to expressed human milk. Certain foods such as fruit purees, squash, yogurt, and ground oatmeal may effectively thickened human milk and maintained a similar thickness level over the course of 20 minutes, and could be considered for older infants with dysphagia if cleared by the medical team.