How and Why to Thicken Liquids

Some children have trouble swallowing. This is called dysphagia (dis-fay-juh). Children with dysphagia need to have their food and drinks changed so they can safely eat and drink.

If your child has dysphagia, you may need to make the liquids they drink thicker. Thickened liquids move more slowly than thin liquids. This gives your child extra time to control the liquid while swallowing and keep it out of the lungs. This helps protect their airway.

How to Thicken Liquids

• If your child is under the age of 12 months, it's recommended that you use infant cereal to thicken liquids.
  • Do not use infant cereal in human milk. Human milk breaks down cereal, and it won't keep it thick. If you have questions, talk to your child’s doctor or health care provider.
  • Use measuring spoons to figure out cereal amounts. Do not use kitchen spoons.
• Below are the instructions for thickening with infant cereal. In the chart, tsp is teaspoons and oz is ounces. Follow these levels if your child is under 12 months (corrected age):

	Level 1 IDDSI Slightly thick
	Level 2 IDDSI Mildly thick/nectar
	Level 3 IDDSI Moderately thick/honey

Similac® Level 1     ¾ to 2 tsp cereal/oz formula Level 2     1 ½  to 2 ½ tsp cereal/oz formula Level 3     1 ¾ to 3 tsp cereal/oz formula	Elecare® Level 1     1 ½ to 2 ¼ tsp cereal/oz formula Level 2     1 ¾ to 2 ¾ tsp cereal/oz formula Level 3     2 ¼  to 3 ¼ tsp cereal/oz formula
Neocate® Level 1     1 to 2 ½ tsp cereal/oz formula Level 2     1 ½  to 2 ¾ tsp cereal/oz formula Level 3     2 ¼ to 3 ¼ tsp cereal/oz formula	Enfamil™ (excludes Enfamil AR) Level 1     ½  to 2 tsp cereal/oz formula Level 2     1 to 2 ½ tsp cereal/oz formula Level 3     1 ¾  to 3 tsp cereal/oz formula
Pediasure® Level 1     ½ to 1 ¾ tsp cereal/oz formula Level 2     1 to 2 ¼ tsp cereal/oz formula Level 3     1 ¾  to 3 tsp cereal/oz formula	Boost®Kids Essential Level 1     ½  to 1 ½ tsp cereal/oz formula Level 2     ¾  to 2 tsp cereal/oz formula Level 3     1 ½  to 2 ¾ tsp cereal/oz formula
Other formulas Level 1     ½  to 2 ¼ tsp cereal/oz formula Level 2     ¾  to 2 ¾ tsp cereal/oz formula Level 3     1 ½ to 3 ¼ tsp cereal/oz formula

• Any liquid thickened with infant cereal should be flow-tested before feeding. This makes sure it's the right consistency. To make sure products are thickened correctly, use the simple test shown below (Picture 1).Use an IDDSI funnel to test liquid flow rate.

 

 

Tips for Thickening

• When you prepare the drink with infant cereal for the flow test, mix only 1 ounce of drink or formula. When you reach the correct level, mix the rest of the drink or formula that you need, using the same amount of cereal for each additional ounce (Picture 2).
• When using infant cereal, if your flow test is too thin, add more infant cereal by ¼ teaspoon. If it is too thick, decrease infant cereal by ¼ teaspoon.
• We recommend the use of “pulverized” infant cereal, such as Earth's Best^®, for thickening if your child is under 12 months of age corrected.
• If you use infant cereal flakes, such as Gerber^®, add it to a plastic bag and run a can or a rolling pin over the bag to crush the cereal, or use a blender to pulverize the cereal more.
• Thicken the contents of each bottle right before feeding. If using cold formula, mix the cereal in after the formula has been warmed. Shake it hard to mix the cereal and liquid well.  Offer thickened formula right away. The formula will keep getting thicker as it sits.
• Check the nipple during the feeding to make sure it's not clogged with cereal. You may need to roll the nipple with your fingers or clean out the clog.

Important Notes

• Ask your child’s doctor, health care provider, or pharmacist how to thicken liquid medicines.
• Talk to 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 so the thickened liquids can get through. Talk with your child’s doctor, speech language pathologist, or occupational therapist before making any changes.
• Let your child’s doctor or health care provider know as soon as possible if they're:
  • Eating less than normal
  • More irritable
  • Having constipation
  • Not gaining weight as expected
  • Coughing or choking during feeds
  • Having less wet diapers

Artificial Thickeners

Do not use fake (artificial) thickeners unless your child is over 12 months old (corrected). For questions about corrected age, ask your child’s doctor or health care provider.

Follow the manufacturer’s thickening instructions on the can or packet.

Where to Buy Artificial Thickeners 

There are a lot of name-brand thickeners. You can get artificial thickeners at your local pharmacy. You can also order thickener online or by phone. Always follow the manufacturer’s packaging instructions for thickening.

Simply Thick^®

www.simplythick.com

1 (800) 205-7115

This product can also be used with human milk 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 of age with a history of necrotizing enterocolitis (NEC).

	Level 1 IDDSI Slightly thick – Use slightly thick packet (Level 1 Slightly Thick) with 4 ounces of liquid or use nectar (Level 2 Mildly Thick) packet and mix with 6 ounces of liquid.
	Level 2 IDDSI Mildly thick/nectar – Mix one packet of mildly thick/nectar with 4 ounces of liquid.
	Level 3 IDDSI Moderately thick/honey – Mix one packet of moderately thick/honey with 4 ounces of liquid.

 

Purathick™

www.healthierthickening.com/purathick/

1 (866) 950-7278

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 an allergy to galactomannans.

	Level 1 IDDSI Slightly thick – Mix one packet with 7 to 8 ounces of liquid.
	Level 2 IDDSI Mildly thick/nectar – Mix one packet with 5 to 6 ounces of liquid.
	Level 3 IDDSI Moderately thick/honey – Mix one packet with 3 to 4 ounces of liquid.

 

There are other products on the market to thicken liquids. Talk to your doctor or health care provider before using a thickening product.

 

 

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