Some children have trouble swallowing. This is called dysphagia (dis FAY geh ah). Children with dysphagia need to have their food and drink changed so they can safely eat and drink.
If your child has dysphagia, you may need to thicken the liquids he or she drinks. Thickened liquids move more slowly than thin liquids. This gives your child extra time to control the liquid while swallowing. Thickened liquids may help to protect the airway.
How to Thicken Liquids
If your child is under the age of 12 months, it is recommended that you use infant cereal to thicken liquids. DO NOT use infant cereal in breast milk. Breast milk breaks down the cereal and it does not remain thickened. If you have questions, talk to your child’s doctor.
Use measuring spoons to figure amounts. Do not use regular kitchen spoons.
- Nectar Thick: Use 1 ½ teaspoons of dry infant cereal (rice, barley, oatmeal, mixed) for EACH ounce of formula. Infant cereal must be ground up or pulverized. Do NOT use flake cereal.
- 3 ounce bottle = 4 ½ teaspoons infant cereal (1 ½ tablespoons)
- 4 ounce bottle = 6 teaspoons infant cereal (2 tablespoons)
- 6 ounce bottle = 9 teaspoons infant cereal (3 tablespoons)
- Honey Thick: Use 2 ½ teaspoons of dry infant cereal (rice, barley, oatmeal, mixed) for EACH ounce of formula. Infant cereal must be ground up or pulverized. Do NOT use flake cereal. Do NOT give real honey to children under 1 year old.
- 3 ounce bottle = 7 ½ teaspoons infant cereal (2 ½ Tablespoons)
- 4 ounce bottle = 10 teaspoons infant cereal (3 Tablespoons + 1 teaspoon)
- 6 ounce bottle = 15 teaspoons infant cereal (5 Tablespoons)
Examples of liquids that are naturally the thickness of nectar are:
- Tomato juice
- Peach and apricot nectars (often found with Hispanic foods at the grocery store)
Thickening Liquids Naturally
If your child is over the age of 12 months and is not at risk for allergies, you may try the following natural ways to thicken:
- Add milk to yogurt or pudding. Add the liquid slowly and stir to prevent clumping.
- Mix juice with baby food or blended fruits.
- Mix flavored or non-flavored gelatin with juice in a blender.
- Add bread crumbs, potato flakes, crushed crackers, or pureed meats to stews and soups.
Use these recommendations once you are familiar with using infant cereal or artificial thickener.
Tips for thickening:
- Shake hard to mix the cereal and liquid well.
- Thicken contents of each bottle just before feeding. The formula will keep getting thicker as it sits.
- Infant cereal does not mix well with breast milk. The enzymes in breast milk break down the cereal. If you would like to keep breast feeding or using expressed milk in a bottle, talk to your child’s doctor.
- Check the nipple during the feeding to make sure the cereal has not clogged the nipple. You may need to roll the nipple with your fingers or clean out the clog.
- Talk with your child’s doctor about how to thicken liquid medicines.
- Some foods melt to a thin liquid and must be considered a thin liquid (such as popsicles, ice cream and Jell-O®).
- Speak with your child’s doctor or registered dietitian if you have questions about how these changes may affect the amount of liquid and how many calories your child is getting.
- Your child may need a different bottle nipple to allow the thickened liquids to get through. Talk with your child’s doctor, Speech Language Pathologist or Occupational Therapist before any changes are made.
- Let your child’s doctor know as soon as possible if the child is:
- Not taking the amount of formula he should be
- More irritable
- Having problems with constipation
- Not gaining weight as expected
- Having problems with coughing or choking during feeds
Do not use artificial thickeners unless your child is over 12 months of age corrected. (If you have questions about corrected age, ask your child’s nurse or doctor.)
Follow manufacturer’s thickening instructions on the can or packet of thickener. See the end of this Helping Hand for a list of thickeners, how and where to purchase, and age restrictions.
Where to buy Artificial Thickeners
Several name-brand thickeners can be found on the market. Follow each manufacturer’s directions exactly. You can get artificial thickeners at your local pharmacy. You can also order the thickener online or by phone. Containers of juice, milk and water pre-thickened to either nectar or honey consistencies are available also.
**This product can also be used with breastmilk if your child is over 12 months of age corrected. This product should not be used for any child under the age of 12 years with a history of necrotizing enterocolitis (NEC).
**This product can be used if your child is over 12 months of age corrected. This product should not be used if your child has galactosemia or allergy to galactomannans.
**There are other commercially available products used to thicken liquids. We recommend that you discuss any other product not listed above with your physician to determine the risks and benefits of that product.
HH-IV-105 ©2013, Revised 2020, Nationwide Children’s Hospital