Increased viscosity of milk during infant feeding improves swallow safety through modifying sucking in an animal model.

Increased viscosity of milk during infant feeding improves swallow safety through modifying sucking in an animal model.

Mayerl CJ; Edmonds CE; Gould FDH; German RZ

Journal Of Texture Studies

2021

2021-03-30

Infants experiencing frequent aspiration, the entry of milk into the airway, are often prescribed thickened fluids to improve swallow safety. However, research on the outcomes of thickened milk on infant feeding have been limited to documenting rates of aspiration and the rheologic properties of milk following thickening. As a result, we have little insight into the physiologic and behavioral mechanisms driving differences in performance during feeding on high viscosity milk. Understanding the physiologic and behavioral mechanisms driving variation in performance at different viscosities is especially critical, because the structures involved in feeding respond differently to sensory stimulation. We used infant pigs, a validated animal model for infant feeding, to test how the tongue, soft palate, and hyoid respond to changes in viscosity during sucking and swallowing, in addition to measuring swallow safety and bolus size. We found that the tongue exhibited substantive changes in its movements associated with thickened fluids during sucking and swallowing, but that pharyngeal transit time as well as hyoid and soft palate movements during swallowing were unaffected. This work demonstrates the integrated nature of infant feeding and that behaviors associated with sucking are more sensitive to sensorimotor feedback associated with changes in milk viscosity than those associated with the pharyngeal swallow, likely due to its reflexive nature.

Aspiration, the entry of food or liquid into the airway, is especially prevalent in infant mammals relative to adults (Jadcherla, 2016; Stricklen, Bond, Gould, German, & Mayerl, 2020). High rates of aspiration can have detrimental health impacts, and in the most extreme cases result in aspiration pneumonia and death (Logemann, 2007; Prasse & Kikano, 2009). One of the most commonly accepted methods of reducing the occurrence of aspiration in infants is increasing the viscosity of ingested material (Cichero, Nicholson, & September, 2013; Newman, Vilardell, Clavé, & Speyer, 2016). The clinical outcomes of increased viscosity in infants are fairly well understood, and include reduced occurrence of regurgitation and aspiration, and increased weight gain (Krummrich, Kline, Krival, & Rubin, 2017; Salvatore et al., 2018). However, most research on the impact of viscosity on infant feeding has focused on the rheologic properties of the liquid, and how time, temperature, and thickening agent impact viscosity (Gosa & Dodrill, 2017; September, Nicholson, & Cichero, 2014; Yoon & Yoo, 2017). As a result, we have very little insight into the physiologic mechanisms driving differences in performance due to changes in viscosity.

Journal Article

NEOMED College of Medicine

Department of Anatomy & Neurobiology

Jan to Aug list 2021