Debbie wrote: "Wolf & Glass recommended Simply Thick over cereals
because the other thickeners are quickly digested by the breastmilk,
returning the milk to its original thinner consistency. Have you found
this to be the case?  It stands to reason that a food would be healthier
than something so high in complex carbohydrates (fiber) as Simply Thick.
Given that the doctors are insisting that she use the more expensive gel
version ($200/month) of Simply Thick rather than the powder, which would
have been covered by insurance, these MDs are quite specific in their
orders."

Yes, the breastmilk does break down the starch in the cereals.  It seems
to me that rice is the fastest and that sometimes the oatmeal can work
slightly better.  It depends on how immediate the aspiration is and what
texture has been observed to be safe.  Many times the mothers are not
pumping or providing 100% breastmilk volume so I will recommend mixing
together so that the texture is more consistent.  ( I know, I know...
but if she is not pumping 100% anyway, she is using some ABM so lets
make it safe for baby and keep mom providing breastmilk)  I have just
seen many situations of aspiration pneumonia, ventilatory support,
Failure to Thrive because the baby is just not comfortable feeding.
Definitely, if it is an exclusively breastfeeding mom, I will make all
attempts possible to keep the baby at breast.  There are times that
without a very thick texture - 1 tablespoon of infant cereal per 1oz of
milk, the aspiration still occurs.  When the thickening is for swallow
and aspiration reasons, if it thins in the stomach, that is not a
problem.  Thickening for aspiration due to reflux, the thickening would
need to remain at that texture in the stomach.  I would love to hear
more from others who have used the commercial thickeners instead of
infant cereal.  I have found that babies will take on average, one ounce
less per feeding when thickened to nectar or honey consistency
(1Tablespoon cereal per 2oz milk , 1 Tablespoon cereal per 1oz milk).
Using the corn/carbohydrate thickeners are concerning to me with no
nutritional value.  At least the oatmeal or rice has a little.  Any
evidence based info out there?

I am not sure why they only use the expensive gel.  It could be that is
what they used for the study and prefer to prepare the same way so not
to vary the texture.  Another brand ThickIt is easier for families to
find in stores and much cheaper.  

Angie Kirkwood RN BSN IBCLC RLC 

Childrens Hospital of Pittsburgh, Pennsylvania, USA

 



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