I wanted to first say that I have been lurking on Lactnet for several months now, but have never posted.  I have really enjoyed reading all the posts, and am learning so much from all of you.  I am also a Speech Pathologist and new IBCLC.  I wanted to add my 2 cents to the discussion.  

First of all, in terms of using thickening agents to thicken breastmilk to reduce the symptoms of GERD, it in my understanding that not only does it not work, it can reduce the motility of the GI tract, so if there are undiagnosed peristaltic issues, it will make matters worse. 

 And, in terms of thickening breastmilk for dysphagia (swallowing difficulty), I agree, that it should only be used as a last resort.  The issue I have is when you have a breastfed baby (in the NICU, preemie, older baby, etc...) who is showing signs of possible aspiration (coughing for example), without any respiratory illness (aspiration pneumonia for example) or distress, and a Modified Barium Swallow Study is ordered.  So, for the purposes of the study, the same breastfed baby is then asked to drink EBM from a bottle, and the baby aspirates during the study.  What does that really tell us about how he is breastfeeding?  I would guess to say, not a whole lot.  But, now this baby has been shown to aspirate on thin liquids, so something has to be done about it.  Chances are the recommendation will be to thicken liquids (if postural changes, etc...don't make a significant improvement), and that can't be done at the breast.... 

The other issue I have with it is, as Laura also mentioned, even IF the baby is aspirating breastmilk while breastfeeding, how do we know that it is causing any harm or illness?  I have also wondered for quite some time, that breastmilk should be allowed to continue freely, as is often done with water in many hospitals with adult patients who have dysphagia ( See Laura's comment re: Frasier Water Protocol). I would love to see a study done on this. Also, if a baby is already receiving EBM via bottle and is demonstrating difficulty managing the breastmilk (thin liquids), it is important to see if pacing techniques or trying different slow flow nipples, might help him manage EBM better as it may be a flow issue vs. just that it's a thin liquid in need of thickening.

Also, in response to the post regarding 7 month old who has been shown to aspirate on thin liquids...has he had any respiratory infections, such as pneumonia or has he been otherwise healthy and thriving?  If he is, then again I question the recommendations to stop breastfeeding and switch to thickened feeds (on SO many levels).  Unfortunately, as a profession (Speech Pathologist that is), I see it all too often, that the breastfeeding relationship is not taken into consideration, or even the different mechanics of breastfeeding vs. bottle-feeding.  We really need to carefully consider when it is truly appropriate to recommend thickened bottle feeds over breastfeeding (and I'm going to again guess, rarely). The same goes for switching to a "partially digested" formula before looking at the whole picture and ruling out other causes.  Looking to see if the baby could have a TT that could be contributing to his issues, as someone suggested in an earlier post, might be a good place to start.  Or maybe even an upper GI to get a better look at what might be going on with this baby...  I think ruling out EE  (Eosiniphilic Esophagitis/Enteropathies) is a great idea.   Also, an undiagnosed birth trauma could be impacting feeding/swallowing and/or causing GERD...We have a couple osteopaths in town who have done wonders for babies with these issues.  There are so many possible causes and it may be multifactorial.  Stephanie, I wish you luck in helping this mom and baby!!

Nina Isaac, MS, CCC-SLP, IBCLC, LLLL
Tucson, AZ
Mother of 3 girls, who is enjoying her other role as Speech Pathologist, and now IBCLC, after many years at home with my girls :)

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