Thickening Infant Formula Using Commercial Thickeners: The Reliability of Manufacture Provided Recipes
Background: A growing number of infants are suffering from swallowing deficits (dysphagia). These deficits are a source of pulmonary morbidity if left untreated. Provision of thickened liquids through the addition of commercial thickener to infant formula are a common treatment to mitigate these deficits. While there are a variety of commercial thickeners available, little is known regarding the ability of these thickeners to reach desired thickness levels. This investigation evaluated the validity of three manufacturer-provided thickeners and their associated recipes.
Methods: Similac AdvanceⓇ powder formula was thickened with SimplythickⓇ, PuraThickTM, and GelmixⓇ according to manufacturer instructions. Formula thickness was evaluated using International Dysphagia Diet Standardization Initiative (IDDSI) gravity flow testing. Each condition underwent testing every 5 minutes for 30 minutes following thickening to simulate a typical bottle-feed.
Results: SimplythickⓇ recipes met IDDSI slightly thick, mildly thick, and moderately thick criteria. PuraThickTM recipes met corresponding IDDSI thickness level criteria, however not until 10-35 minutes after the recommended wait time (10 min. slightly thick; 15 min. mildly thick; 30 min. moderately thick). The only GelmixⓇ recipe to meet IDDSI criteria was moderately thick, which met the criteria after 20 minutes.
Conclusions: The validity of commercial thickeners and their associated manufacturer-provided recipes is variable across brands. Although SimplythickⓇ recipes were found to be valid, those provided by PuraThickTM and GelmixⓇ were not according to IDDSI classification criteria. Future investigations examining the source for these discrepancies, whether recipe formulation or thickener chemical content, are warranted to enable the provision of effective dysphagia interventions.