First off, was the baby aspirating DURING BREASTFEEDING? Were there 
clinical issues (recurrent pneumonia?). Often, a baby who aspirates 
while being bottle fed on a videofluoroscopic swallowing study is taken 
off the breast, even though they are doing better at breast, so milk can 
be thickened. There are problems with nutrient absorption with 
thickeners according to research studies, and thickening is not all that 
effective either. Lisa Sandora (speech therapist and IBCLC) and I cover 
this in chapter 1 of Supporting Sucking Skills in BF infants, which you 
can read online at Google books (so no commercial intended). The refs 
are there too.

If the baby was not aspirating during bf, or was not having clinical 
problems due to aspiration, then management changes to improve baby's 
ability to handle flow may be sufficient. You can help with that! If the 
baby was having clinical problems from bf, then perhaps feeding with 
thickeners is justified.

Catherine Watson Genna, BS, IBCLC  NYC

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