Susan Burger writes: "Again, having watched those videoflurorscopes I do
believe that the observations are correct about aspiration, but I have
not yet seen evidence-based proof that the intervention of using a
thickener is better than feeding at the breast in positions that
minimize aspiration because I haven't seen studies that do the
videofluoroscope when an infant is feeding at the breast. Nor have I
seen any study that investigates the benefits and weighs these against
other potential harm."

You are absolutely correct with lack of evidece base studies comparing
breastmilk being aspirated being safer that using any form of texture to
breastmilk.  I just cant imagine that a Review Board would approve a
research study looking at aspiration of breastmilk vs thickened feeding.
Allowing any liquid into the lungs would not be considered safe for the
subject group.  Unfortunately, empirical practice seems to be the best
alternative until further evidence is reported.  I am sure if we asked
Pulmonologists, they would provide adequate evidence, that any liquid as
sterile as gel thickener or as precious as breastmilk will still cause
respiratory complications when lung tissue if exposed on a regular
basis.  If a breastfeeding mother has a swallow study that shows
aspiration and she chooses to continue breastfeeding, that is her
decision and I will assist the SLP's to discuss the ways of decreasing
the suck swallow breathe pace, position etc, etc...  It will be strongly
recommended to thicken the breastmilk and feed via bottle to prevent
breastmilk in the airway and most likely a follow up study.

Angie Kirkwood



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