Abbey Sterkowitz

Background: Medical advances have resulted in an increased prevalence of infants suffering from swallowing deficits (dysphagia) leading to recurrent respiratory morbidities. Provision of thickened liquids, using rice or oatmeal cereals, is a leading treatment. Difficulties dissolving cereals in formula often leads clinicians to recommend cereal pulverization to break down flakes prior to mixing. However, little is known regarding how cereal type and particle size influences thickness. This investigation tested the differences in thickening effects of rice and oatmeal cereals in off-the-shelf and pulverized formulations. Methods: Similac Advance formula (20kcal/oz) was thickened with graduated volumes (2, 3, 4, 5tsp cereal/2oz formula) of Gerber, Gerber Organic, Earth’s Best, and Beechnut cereals. Thickened formulas underwent 30 minutes of IDDSI gravity-flow testing. Trials resulting in syringe clogging were demarcated, with remaining values categorized into IDDSI levels. Differences in dry cereal particle size were measured using an Olympus-IX73 microscope. Results: Only Beechnut cereals mixed cohesively in formula without clogging; yielding the lowest variability in residual volume. Among Beechnut brand, no differences in IDDSI level were found across rice and oatmeal formulations, with 2, 3, 4, 5 tsp/oz yielding thin, slightly thick, mildly thick, and moderately thick levels respectively. In contrast, Gerber cereals clogged the most trials of all brands resulting in high variability among residual values causing discrepancies across trials. Conclusions: The ability to reliably thicken formula using infant cereal is greatly influenced by brand. Beechnut, with its smaller grain size, generated more reliable thickening effects than those with larger grain sizes.