How and Why to Thicken Liquids

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Some children have trouble swallowing. This is called dysphagia (dis-fay-juh). 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 they drink. 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 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 human milk. Human milk breaks down the cereal and it does not stay thickened. 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 regular kitchen spoons.

New guides have been put in place by the International Dysphagia Diet Standardisation Initiative (IDDSI) to help with your child’s diet. Below are the instructions for thickening with infant cereal if your child is under 12 months corrected age for the following levels:

Visual explaning the difference between level 1,2, and 3 thickness.

Level 1 IDDSI Slightly thick

How to use artificial thickeners: Simply Thick.

Level 2 IDDSI Mildly thick/nectar
How to use artificial thickeners: Purathick.

Level 3 IDDSI Moderately thick/honey

Similac®

Level 1     1 to 2 tsp cereal/oz formula

Level 2     1 ½  to 2 ½ tsp cereal/oz formula

Level 3     2 to 3 tsp cereal/oz formula

Gerber®

Level 1     1 ½  to 2 ¼ tsp cereal/oz formula

Level 2     2 to 2 ¾ tsp cereal/oz formula

Level 3     2 ½  to 3 ¼ tsp cereal/oz formula

Elecare®

Level 1     1 ¾  to 2 ¼ tsp cereal/oz formula

Level 2     2 to 2 ¾ tsp cereal/oz formula

Level 3     2 ½  to 3 ¼ tsp cereal/oz formula

Enfamil™ (excludes Enfamil AR)

Level 1     1 ¼  to 2 tsp cereal/oz formula

Level 2     1 ¾  to 2 ½ tsp cereal/oz formula

Level 3     2 ½  to 3 tsp cereal/oz formula

Neocate®

Level 1     2 to 2 ½ tsp cereal/oz formula

Level 2     2 ½  to 2 ¾ tsp cereal/oz formula

Level 3     3 to 3 ¼ tsp cereal/oz formula

Enfamil AR™ 20

Level 1     ¾  to 1 tsp cereal/oz formula

Level 2     1 ½  to 2 tsp cereal/oz formula

Level 3     2 to 2 ½ tsp cereal/oz formula

Bright Beginnings® Soy

Level 1     1 ¼  to 1 ¾ tsp/oz infant cereal

Level 2     1 ¾  to 2 ¼ tsp/oz infant cereal

Level 3     2 ½  to 2 ¾ tsp cereal/oz formula

Boost®Kids Essential

Level 1     1 ¼  to 1 ½ tsp cereal/oz formula

Level 2     1 ¾  to 2 tsp cereal/oz formula

Level 3     2 ¼  to 2 ¾ tsp cereal/oz formula

Pediasure®

Level 1     1 to 1 ¾ tsp cereal/oz formula

Level 2     1 ½  to 2 ¼ tsp cereal/oz formula

Level 3     2 ¼  to 3 tsp cereal/oz formula

Other formulas

Level 1     ¾  to 2 ¼ tsp cereal/oz formula

Level 2     1 ½  to 2 ¾ tsp cereal/oz formula

Level 3     2 to 3 ¼ tsp cereal/oz formula

Any liquid thickened with infant cereal should be flow-tested before feeding. This makes sure it is 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.

IDDSI Flow Chart

 

 

Thicken liquids with infant cereal. Check for proper thickness level.

Tips For Thickening

  • When you prepare the drink with infant cereal for the flow test, mix only 1 ounce of drink or formula. Once 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, increase the amount of 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 Beechnut®, 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.

Other 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 are:
    • Eating less than normal
    • More irritable
    • Having problems with constipation
    • Not gaining weight as expected
    • Having problems with coughing or choking during feeds
    • Having less wet diapers

Artificial Thickeners

Do not use fake (artificial ) thickeners unless your child is over 12 months of age 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 of thickener.

Where to Buy Artificial Thickeners 

Many name-brand thickeners can be found on the market. You can get artificial thickeners at your local pharmacy. You can also order the 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 with a history of necrotizing enterocolitis (NEC).

Visual explaning the difference between level 1,2, and 3 thickness.

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.

How to use artificial thickeners: Simply Thick.

Level 2 IDDSI Mildly thick/nectar – Mix one packet of mildly thick/nectar with 4 ounces of liquid.
How to use artificial thickeners: Purathick.

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 allergy to galactomannans.

Visual explaning the difference between level 1,2, and 3 thickness.

Level 1 IDDSI Slightly thick – Mix one packet with 7 to 8 ounces of liquid.

How to use artificial thickeners: Simply Thick.

Level 2 IDDSI Mildly thick/nectar – Mix one packet with 5 to 6 ounces of liquid.
How to use artificial thickeners: Purathick.

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. We recommend that you discuss any other product not listed above with your doctor or health care provider to see if it's a good choice for your child.

 

How and Why to Thicken Liquids (PDF), Somali (PDF), Spanish (PDF)

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