Evidence Share: Findings and Clinical Implications for Thickening Formula

Published by Feeding Matters on Nov 18, 2022

Citation: Stevens M, Therapies Dof C, O’Rourke S, et al. Clinical focus: Findings and clinical implications for thickening formula with infant cereal using the International Dysphagia Diet Standardization Initiative Flow Test. ASHA Wire.
https://pubs.asha.org/doi/full/10.1044/2022_AJSLP-21-00298. Published December 17, 2021. Accessed September 6, 2022.

Summary: Neonates who present with dysphagia may require dietary modifications to improve swallowing safety. Thickening formula and breast milk is a common practice in pediatric hospitals as a management technique. However, the empirical information available to practitioners in guiding care and texture modifications for infants with dysphagia is limited. The International Dysphagia Diet Standardization Initiative (IDDSI) was founded as a means to provide objective measures for effective evaluation of dietary consistencies and provide common terminology to describe food textures and drink thickness. One large pediatric hospital set out to identify a common recipe to thicken formula with infant cereal. In the process, over 90 formulas were combined with rice and oatmeal cereals at increasing increments and systematically tested at IDDSI level 1 (thin/no cereal) to levels 2 (slightly thick) and 3 (mildly thick). Due to variability in formula and cereal formula combinations, no standard recipe could be determined. The intra- and interclinician variability was low, whereas the formulas themselves were highly variable across brand and form (e.g., ready to feed, concentrate, or powder). More research is needed; still, it can be concluded that following the IDDSI guidelines for flow testing may be more critical in carryover for families and staff than a common recipe.