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ASHA's National Center for Evidence-Based Practice in Communication Disorders

Thickened Liquids as a Treatment for Children with Dysphagia and Associated Adverse Effects: A Systematic Review

Supplementary Materials

Table summarizing the participant characteristics of studies examining the effects of thickened liquids in children with dysphagia (Clinical Question1).

Table summarizing the findings from studies examining the effects of thickened liquids in children with dysphagia (Clinical Question1).

Table summarizing the participant characteristics of studies examining adverse effects (Clinical Question 2).

Table summarizing the findings from studies examining adverse effects (Clinical Question 2).

Quality indicators of the included studies.

Detailed search methodology.


Participant Characteristics of Studies Examining the Effects of Thickened liquids in Children with Dysphagia (Clinical Question1)

Citation Total N (number available for analysis)

Mean Age (Range), mo

Gender Medical Diagnosis Weight Description of Swallowing Disorder/Assessment

Medications

Mercado-Deane et al,20

2001

126 (120) Participants < 12 mos (NR)

NR Suspected GER-additional diagnoses included prematurity, esophageal atresia, bronchopulmonary dysplasia, neurologic abnormality, or congenital heart disease

NR MBSS with thin liquids, thick liquids, and pureed food revealed tracheal aspiration or laryngeal penetration

NR

Khoshoo et al,23 2001

9 NR (3-12) NR Neurologically intact, clinically stable infants with RSV bronchiolitis and dysphagia including laryngeal penetration,tracheal penetration,and aspiration

NR VFSS with thin and thickened liquids

NR

Sheikh et al,242001

13 (9) 5.4 (NR) F= 4 M= 9

Dysphagia with silent chronic aspiration and recurrent respiratory symptoms

Mean weight 7.5 kg- allpercentiles for weight were between 25-50

VFSS to assess oral, pharyngeal and esophageal phases of swallow with thin, semi-thick, and thick consistencies. All participants demonstrated direct aspiration on VFSS.

Asthma medications continued during study


Kuroki et al,25

19962 Participant 1:

2 mosParticipant 2: 1 mo

F=2 Intractable wheezing Participant 1 (at birth): 2654 gParticipant 2 (at birth): 3218 g

MBSS revealed nasopharyngeal reflux and cricopharyngeal incoordination.

Participant 2 occasionally given an expectorant and bronchodilator.

Frazier and Friedman,26

1996

19 (10) 24 (3-47) F= 3 M=16

Down syndrome and dysphagia

NR MBSS with thin liquids, thick liquids, puree, and solids (based on developmental level) -examined oral preparation, reflex initiation, pharyngeal clearing, aspiration, and cricopharyngeal screening

None reported

Schroeder et al,27 2008

52 (12) 8.2 (1 – 96) F= 22 M= 30

Severe laryngomalacia. Some also diagnosed with respiratory distress or failure to thrive.

NR VFSS was performed to confirm or deny post-surgical aspiration.

NR

Abbreviations: GER, gastroesophageal reflux; MBSS, modified barium swallow study; NR, not reported; RSV, respiratory syncytial viral, VFSS, videofluorscopic swallow study.


Findings from Studies Examining the Effects of Thickened liquids in Children with Dysphagia (Clinical Question1)

Citation Thickener Composition

Amount of Thickener

Treatment Duration Outcome Measures and Major Findings Status with thickened liquids compared to thin liquids.

Other Related Findings

Mercado-Deane et al20

2001

Rice cereal 1 tblsp rice cereal/ oz thin liquid

Evaluation only Tracheal aspiration (n=89) Infants unable to swallow thicker consistencies were placed on tube feedings (n=32) until successful, safe swallowing was demonstrated on repeat MBSS. Swallowing usually improved by one year of age unless the infant presented with severe neurologic dysfunction

Eliminated 42% (37/89)

No change 39% (35/89)

Laryngeal penetration 19% (17/89)

Laryngeal penetration (n=31)


No change 29% (9/31)


Rice cereal 4g/30 mL of barium (85% barium sulfate suspension)

Evaluation only Laryngeal penetration (n=3) NoneEliminated 100% (3/3)

Tracheal penetration (n=2)


Aspiration (n=4)Eliminated 75% (3/4)

No change 25% ( 1/4)

Sheikh et al,24 2001

Rice cereal 1 tblsp rice cereal/oz of thin liquid barium (70%

3 mos Aspiration with thin liquids (n=7) 4 different participants aspirated thin, semi-thick, and thick Eliminated 100% (7/7)


concentrated: Barosperse barium sulfate suspension)

Aspiration with thin and semi-thick consistencies (n=2) consistencies and received tube feedings- aspiration resolved for all at 9-mo follow-up


Kuroki et al,25 1996

Corn starch NR Participant 1: NRParticipant 2: ≥ 1 mo

Nasopharyngeal reflux Both infants demonstrated normal growth and development at follow-up

Participant 1 Eliminated at 10-mo follow-up MBSS

Participant 2 Eliminated at 6-mo follow-up MBSS

Intractable wheezing

Participant 1 Eliminated

Participant 2 Eliminated

Frazier andFriedman,26

1996

NR Varied based on oral-motor development

Evaluation only Delayed swallow with thin liquids (n=10) NoneNo change 80% (8/10)

Improved 10% (1/10)


Aspiration with thin liquids (n=7)Eliminated 71% (5/7)

No change 29% (2/7)

No aspiration with thin liquids (n=3)

Worsened 33% (1/3)


NR NR 7-18 mo Post-operative aspiration with thin liquids (n=12) None

Eliminated with thickened feeds

50% (6/12)

No change with thickened feeds

50% (6/12: participants went on to receive NG tube feedings and thickened feeds)


Aspiration with thickened liquids (n=6: same participants as no change with thickened feeds group)

Eliminated with 4 mos of NG tube feedings plus 6-18mos of thickened feeds

100% (6/6)

Abbreviations: MBSS, modified barium swallow study; NG, nasogastric; NR, not reported or calculable.


Participant Characteristics of Studies Examining Adverse Effects (Clinical Question 2)

Citation N (number available for analysis)

Mean Age (Range) Gender Medical diagnosis Mean weight Reported medications

Miyazawa et al,28

2008TF 1= 9TF 2= 9

11.7 y (NR) F= 2 M=16

Cerebral palsy and GERD. All subjects received enteral feeds (NG tube)

NR- 2/18 were of average weight the rest were below the 3rd percentile

Some participants received acid suppressors or prokinetics (Gasmotin) during study

Vanderhoof et al,29 2003

SF = 49TF = 55 (54)

SF:58 days (NR)TF:61 days (NR)

SF:F=23M= 26

TF:F=28M=27

Regurgitant GER SF = 5023 gTF= 5207 g

Pharmacological intervention as needed:Ranitidine any time after day 7/8Cisapride any time after day 14/15Three babies received pharmacotherapy: TF group = 2; SF group = 1

Vivatvakin andBuachum30 2003

20 13.4 wks (NR) F= 8 M= 12

Full-term infants with non-pathological GER (accompanied by regurgitation)

4943 g Infants developing gastroparesis received domperidone or cisapride

Chao andVandenplas31 2007

SF= 40TF = 41

SF: 90.5 days (NR)TF: 90.2 days (NR)

F= 39 M=42

Frequent regurgitation/vomiting

SF = 5466.1 gTF = 5423.4 g

None

Moukarzel et al,32

2007SF = 38 (32)TF = 36 (28)

3.24 mos (NR) F= 34 M= 40

Healthy term infants diagnosed with GER

NR None


Xinias et al,33

2003SF = 28TF = 28

3.1 mos (NR) F= 26 M= 30

Mild to moderate GER accompanied by recurrent vomiting

NR None

Levtchenko et al,34 1998

SF= 20 TF = 20

newborns NR Healthy infants SF = 3328 gTF=3472 g

None

Miyazawa et al,35

200720 36 days (NR) F= 12

M=8Frequent regurgitation/vomiting GER

4357.2 g None

Miyazawa et al,36

2004TF 1= 16TF 2= 14 (11)

TF 1:130.9 days (NR)TF 2:124.5 days (NR)

F=16M=14

Uncomplicated GER (daily regurgitation)

TF 1= 6726 gTF 2= 6185 g

None

Hegar et al,37 2008 SF =20 TF 1= 20TF 2= 20

SF: 47.1 days (NR)TF 1:48.7 days (NR)TF 2:46.2 days (NR)

F=38 M=22

Healthy term infants with frequent regurgitation/vomiting

SF = 5037 gTF 1 = 5010 gTF 2 = 4855 g

None

Orenstein et al,38

198720 NR (4−24 wks) NR Gastroesophageal

reflux – one infant was also diagnosed with Pierre Robin syndrome

NR None

Orenstein et al,39

199225 Median= 7.5 weeks (7

weeks corrected for gestational age

NR GER NR None

Ramirez-Mayans et al,40 2003

TF 1= 24TF 2 = 28

TF 1: 1.93 mos (NR)TF 2: 2.52 mos (NR)

F= 21 M=31

Non-pathological GER TF 1 = 4670 gTF 2 = 4950 g

None


Wu et al,412001 30 3.78 mos (NR) F= 16 M=14

Simple GER 6587 g None

Miyazawa et al,42

2006- Phase 2TF 1= 14TF 2= 13

NR NR for Phase 2

Recurrent regurgitation but no symptoms indicating GER-related complications

NR None

Penna et al,43 2003 SF =48 TF =52

NR (0-12 mos) NR Uncomplicated GER NR None

Note: g= grams; GER= gastroesophageal reflux; NR= not reported or calculable; SF = standard formula group; TF = thickened formula group


Outcomes from Studies Examining Adverse Effects (Clinical Question 2)

Citation Formula/thickening agent (Brand)

Treatment frequency and duration

Feeding method

Outcome measures and major findings Related findings

Statistical significance

Effect size (95% CI)

Miyazawa et al,282008

SF: enteral formula (K4A)

TF 1 -low pectin: Enteral formula (K4A):pectin liquid= 3:1

TF 2-high pectin: Enteral formula (K4A):pectin liquid= 2:1

8 wks-4 wks on a pectin diet (high or low) and 4 wks on a non-pectin diet

Enteral feeds (NG)

Median cough score – TF 1 vs. SF: P<.05(favoring TF 1)

NR None

Median cough score – TF 2 vs. SF: P<.05 (favoring TF 2)

NR

Vanderhoof et al,29 2003

SF: commerciallyavailable cow-milk-based infant formula (NR)

TF: pregelatinized rice starch (Enfamil AR)

5 wks Bottle Choke/gag/cough rate-end of week 1: P<05(favoring TF)

NR 17 (13% of TF group and 20% of SF group; NS) babies discontinued study due to reasons related to the formula -intolerance, failure to thrive, or parental election.

5 infants were discontinued for non-formula reasons- loss to follow-up, illness induced failure to consume adequate formula, and one serious adverse event.

Choke/gag/cough rate-end of study: P<.05(favoring TF)

NR

Constipation : NS at end of week 1 or at end of study

NR

Diarrhea: NS at end of week 1 or at end of study

NR

Incidence of serious adverse events: NS at end of week 1 or at end of study

NR


Vivatvakin and Buachum,30

2003

SF: cow’s milk infant formula (NR)

TF: carob bean gum (NR)

4 wks-2 wks on SF and 2 wks on TF

Bottle Weight gain/wk: P< .01 (favoring TF)

d (repeated measures)= 1.04 (-58.65 4−5.18)

Colic rate: NSGastroparesis: NS

Less night coughing:P<.01 (favoring TF)

NR

Chao andVandenplas,31

2007

SF: strengthened regular formula: (Novalac 1)- 5measurements of formula/120ml water

TF: corn starch (InterNovolac AR)

2 mos for all feeds

Bottle Cough: NS NR 8 children were excluded from the study because they developed diarrhea or enteritis but the authors did not report which formula the children received.

Weight gain at 1 mo:P<.01 (favoring TF)

d=1.41 (0.91−1.88)

Weight gain at 2 mos: P<.01 (favoring TF)

d= 1.50 (0.99−1.98)

Moukarzel et al,32 2007

SF: regular infant formula (Wyeth)

TF : pregelatinized corn starch (Wyeth)

1 mo for all feeds

Bottle No adverse events were reported during the study

6 infants from SF group and 8 from TF group (NS) were excluded from the study post-randomization due to the development of GER symptoms that required medical treatment. These symptoms included excessive crying, dysphagia equivalent, refusal to eat, or inadequate weight gain.

Height: NS

Infant weight: NS NR

Xinias et al,33

2003SF: normal milk formula(NR)

TF: corn starch and an

4 wks Parents were told to continue the

Cough rate: NS d= 0 (-0.52− 0.52) Height: NS

No changes in stool consistency or frequency noted


increased amount of casein (NR)

nonmedical instructions for feeding and positioning that they had used prior to the study.

Weight: NS NR during the study


SF: (Nutrilon Premium)

TF : bean gum (Nutrilon AR)

13 wks for all feeds

Bottle Total weight gain: NS

NR Length gain: NS

Weight gain/day: NS

NR

Miyazawa et al,35 2007

SF: (Hagukumi)

TF: locust bean gum/SF= .35g/100 mL

2 wks -one wk of SF and one wk of TF

Bottle The authors reported that no infant had any complications during the test period.

TF resulted in significantly more bowel movements (P<.01) than control formula.

Weight gain over one week: NS

NR


SF: (Hagukumi)

TF 1: locust bean gum/SF = .45g/100 mL

TF 2: locust bean gum/SF= .35g/100 mL

2 wks- one wk of TF (1 or 2) and one wk ofSF

After 2 wks, families were supplied with2 months of preferred formula (TF or SF)

Bottle Authors reported that no infant had any complications during the study.

Bowel movements/day:TF 1: NSTF 2: P<.05Weight gain (g/d)

TF 1: NSNR

Weight gain (g/d)TF 2: P<.05

NR

Weight gain at 7 months of agereported as “similar”across all three groups: NR

TF 1vs. TF 2:d=-0.32 (-1.16− 0.55)(favoring TF 2)

TF1 vs. SF:d=0.69 (-0.4−1.71)(favoring TF 1)


TF2 vs. SF:d= 1.14 (-

0.1−2.22)(favoring TF 2)

Weight gain at 12 months of age reported as “similar”across all three groups: NR

TF 1vs TF 2:d=-0.33(-1.17−0.54)(favoring TF 2)TF1 vs. SF:d=0.39 (-0.67−1.41)(favoring TF 1)TF2 vs. SF:d= 0.79 (-0.39−1.87)(favoring TF 2)

Hegar et al,37

2008SF: NR

TF 1: rice cereal (Nestle)/SF= 5g /100mL

TF 2: bean gum (Nutrilon 1- AR)

4 wks for all feeds

Bottle Weight gain-TF 2 vs. standard: P<.05 (favoring TF 2)

d= 0.84 (0.18−1.47)

Authors reported that stool consistency and frequency did not differ between the groups during the intervention period.Weight gain-TF 2

vs. TF 1: P<0.01(favoring TF 2)

d= 2.87 (1.94−3.69)

Weight gain- SF vs. TF 1: NR

d= -1.91(-2.62− -1.13)(favoring SF)

Orenstein et al,38 1987

SF: radiolabeled infant formula (NR)

TF: dry rice cereal/SF=

Paired feedings separated by 48− 72 hrs to allow for

Fed by nipple with an enlarged hole1 infant fed

Cough rate during the postprandial period: NS

d= -0.44 (-1.06−0.2)(favoring SF)

None


15 ml/30 ml sufficient decay of radionuclide in the initial feeding -20 mins allotted for each feeding with identical fasting periods preceding each one

via gastrostomy tube1 infant became tired and finished her feeding through a nasogastric tube

Aspiration rate: No aspiration was detected in any of the infants

NR


SF: infant’s usual formula (NR)

TF: dry rice cereal (Heinz) - 20 ml/kg of their usual formula mixed with 10 ml/kg of rice cereal

Two 30-min feedings- one with SF and one with TF

Bottle Cough salvos per hour (thickened > unthickened): P<.05

d= -0.35 (-0.9− 0.22)

None

Total coughs per hour (thickened > unthickened): P<.05

d= -0.34 (-0.89−0.22)

Number of coughs during feeding: NS

d= 0 [-0.55, 0.55]

After feeding (thickened > unthickened): P<.01

d= -0.38 (- 0.94−0.18)

Ramirez-Mayans et al,40

2003

TF 1: rice cereal (Wyeth)/SF=5g/100mL

TF 2: pre-gelatinized corn starch (Wyeth)

3 wks Bottle No reports of cough in either group. No dropouts were related to formulas

Three reports of constipation in TF 1 group and no reports of constipation in TF 2 group: NS

NR

Wu et al,41

2001SF: commercially available infant formula(NR)

TF - rice starch (NR)

1wk - allfeeds

Bottle No constipation or diarrhea reported in either group.

NR 13/30 showed hardening of stool pattern but not to adverse level



SF: (Hagukumi)



2 wks- one wk on TF (1 or 2) and one wk on SF

Bottle Authors reported that TF caused no complications.

NR 1/14 in TF 1 group and 2/13 in TF 2 group reported an increase in bowel movements but none of the infants had severe diarrhea.

Penna et al,43

2003TF 1: regular formula for children 0-6 mos or > 6 mos thickened with corn starch.

TF 2: pre-gelatinized corn starch (Nan AR)

3 mos Bottle Authors stated that "no side effects associated with the use of the tested dietary regimen were verified"

NR None


Table 6. Quality Indicators of Included Studies

Citation Clinical question

Study design Study protocola

Assessor blindinga

Sampling/allocationa

Evidence of treatment fidelitya

Significancea Precisiona Intention to treata

Mercado-Deane et al20

2001

1 Case series Adequate description of protocol

NR NR No evidence of treatment fidelity

P value neither reported nor calculable

Neither effect size nor confidence interval reported or calculable

NA


1 Case series Adequate description of protocol

NR Convenience sample/Hand-picked sample

No evidence of treatment fidelity



NA

Sheikh et al,24

20011 Case series Adequate

description of protocol

Assessors not blinded

Convenience sample/Hand-picked sample




NA

Kuroki et al,25

19961 Case study Adequate

description of protocol





NA

Frazier and Friedman,26

1996

1 Case series Inadequate description of protocol


Convenience sample/Hand-picked



Neithereffect size nor

NA


sample confidence interval reported or calculable


1 Case series Inadequate description of protocol




NA


2 Controlled trial-crossover design

Adequate description of protocol

Assessors blinded

Random sample inadequately described


P value reported or calculable


NR

Vanderhoof et al,292003

2 Controlled trial


Assessors blinded


Evidence of treatment fidelity



Not analyzed by intention to treat

Vivatvakin and Buachum,30

2003





Effect size and confidence interval reported or calculable

NR

Chao and Vandenplas,31

2007

2 Controlled trial






Effect size and confidence interval reported or



calculable

Moukarzel et al,32 2007

2 Controlled trial


Assessorsnot blinded

Random sample adequately described





Xinias et al,33

20032 Controlled

trialAdequate description of protocol





NR


2 Controlled trial

Adequatedescription of protocol



Evidence of treatment fidelity



NR


2 Controlled trial –crossover design


Assessors blinded





NR




NR Random sample inadequately described




NR


Hegar et al,37

20082 Controlled







NR




Assessors blinded





NR




Assessors blinded





NR

Ramirez-Mayans et al,40

2003

2 Controlled trial


Assessors blinded





NR

Wu et al,41

20012 Controlled

trial-crossover design



NR No evidence of treatment fidelity


Neithereffect size nor confidence interval reported or calculable

NR








Neither effect size nor confidence

NR


interval reported or calculable

Penna et al,43

20032 Controlled


NR Random sample inadequately described




NR

Abbreviations: NA, not applicable; NR, not reported.aBoldface indicates highest level of quality in that category.


Thickened Liquids EBSR Search Methodology Electronic Databases Searched (24 Total):

PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) CINAHL (EBSCO) Health Source: Nursing (EBSCO) Psychology and Behavioral Sciences Collection (EBSCO) PsycINFO (EBSCO) Communication & Mass Media Complete (EBSCO) Education Research Complete (EBSCO) ComDisDome (CSA) CSA Neurosciences Abstracts ERIC (CSA) LLBA (CSA) CSA Social Services Abstracts ISI Web of Science Cochrane Library (Wiley) ScienceDirect SUMSearch (http://sumsearch.uthscsa.edu/) SpeechBITE (http://www.speechbite.com/) REHABDATA (http://www.naric.com/research/rehab/) TripDatabase (http://www.tripdatabase.com/) Latin American and Caribbean Center on Health Sciences Information (LILACS) (http://www.bireme.br/php/index.php?lang=en) NHS Evidence Health Information Resources (formerly National Library for Health) (http://www.library.nhs.uk/) HighWire Press International Bibliographic Information on Dietary Supplements (IBIDS) GoogleScholar

Keywords:

Dysphagia OR deglutition OR swallowing disorders Thickeners OR thickened liquids OR thickening agents Rice cereal OR xantham gum OR starch OR nectar OR honey OR gel OR consistency OR formula Gastroesophageal reflux (GER) OR gastroesophageal reflux disorder (GERD) OR motility disorders OR weight OR nutrition OR gut adhesion OR necrotising enterocolitis OR reflux OR colic OR intestinal obstruction OR diarrhea Hoarseness OR cough OR abdominal pain OR nausea OR aspiration pneumonia


Expanded Keywords:

(("Deglutition"[Mesh] OR "Deglutition Disorders"[Mesh] OR swallow* OR dysphagi* OR deglutiti*) AND ("Nutritive Value"[Mesh] OR "Food Additives"[Mesh] OR "Foods, Specialized"[Mesh] OR thicken*)) (("Deglutition"[Mesh] OR "Deglutition Disorders"[Mesh] OR swallow* OR dysphagi* OR deglutiti*) AND ("Viscosity"[Mesh] OR "Cereals"[Mesh] OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR carobel OR hydra aid OR thick* OR thik OR consistenc*)) ("Deglutition Disorders/diet therapy"[Mesh] OR "Deglutition Disorders/rehabilitation"[Mesh] OR "Deglutition Disorders/therapy"[Mesh]) AND ("Nutritive Value"[Mesh] OR "Food Additives"[Mesh] OR "Foods, Specialized"[Mesh] OR "Cereals"[Mesh] OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR carobel OR hydra aid OR thick* OR thik OR consistenc*) ("Deglutition"[Mesh] OR "Deglutition Disorders"[Mesh] OR swallow* OR dysphagi* OR deglutiti*) AND ("Gastrointestinal Motility"[Mesh] OR "Gastrointestinal Diseases"[Mesh] OR "Signs and Symptoms, Digestive"[Mesh] OR "Irritable Mood"[Mesh] OR "Nutritive Value"[Mesh] OR "Nutritional Status"[Mesh] OR "Failure to Thrive"[Mesh] OR "Feeding Methods"[Mesh] OR "Weight Gain"[Mesh] OR "Airway Obstruction"[Mesh] OR "Respiration Disorders"[Mesh] OR "Respiratory Aspiration"[Mesh] OR liquid transfer OR hydration OR hydrate*) AND ("Viscosity"[Mesh] OR "Cereals"[Mesh] OR "Food Additives"[Mesh] OR "Foods, Specialized"[Mesh] OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR carobel OR hydra aid OR thick* OR thik OR consistenc*)’ ("Gastrointestinal Motility"[Mesh] OR "Gastrointestinal Diseases"[Mesh] OR "Signs and Symptoms, Digestive"[Mesh] OR "Irritable Mood"[Mesh] OR "Nutritive Value"[Mesh] OR "Nutritional Status"[Mesh] OR "Failure to Thrive"[Mesh] OR "Feeding Methods"[Mesh] OR "Weight Gain"[Mesh] OR "Airway Obstruction"[Mesh] OR "Respiration Disorders"[Mesh] OR "Respiratory Aspiration"[Mesh] OR liquid transfer OR hydration OR hydrate*) AND (thick* OR thik*) ("Gastrointestinal Motility"[Mesh] OR "Gastrointestinal Diseases"[Mesh] OR "Signs and Symptoms, Digestive"[Mesh] OR "Irritable Mood"[Mesh] OR "Nutritive Value"[Mesh] OR "Nutritional Status"[Mesh] OR "Failure to Thrive"[Mesh] OR "Feeding Methods"[Mesh] OR "Weight Gain"[Mesh] OR "Airway Obstruction"[Mesh] OR "Respiration Disorders"[Mesh] OR "Respiratory Aspiration"[Mesh] OR liquid transfer OR hydration OR hydrate*) AND ("Viscosity"[Mesh] OR "Cereals"[Mesh] OR "Food Additives"[Mesh] OR "Foods, Specialized"[Mesh] OR carob OR pectin OR cellulose OR rice OR gum OR starch OR tapioca OR carobel OR hydra aid OR consistenc*) NOT “skin* thickness”


(("Gastrointestinal Motility"[Mesh] OR "Gastrointestinal Diseases"[Mesh] OR "Signs and Symptoms, Digestive"[Mesh] OR "Irritable Mood"[Mesh] OR "Nutritive Value"[Mesh] OR "Nutritional Status"[Mesh] OR "Failure to Thrive"[Mesh] OR "Feeding Methods"[Mesh] OR "Weight Gain"[Mesh] OR "Airway Obstruction"[Mesh] OR "Respiration Disorders"[Mesh] OR "Respiratory Aspiration"[Mesh] OR "Weight Loss"[Mesh] OR "Dehydration"[Mesh] OR "Failure to Thrive"[Mesh] OR liquid transfer OR hydration OR hydrate*) AND ("Viscosity"[Mesh] OR "Cereals"[Mesh] OR "Food Additives"[Mesh] OR "Foods, Specialized"[Mesh] OR carob OR pectin OR cellulose OR rice OR gum OR starch OR tapioca OR carobel OR hydra aid OR consistenc* OR enfamil*) NOT “skin* thickness”) AND thick* (thickener[All Fields] OR thickened[All Fields] OR thik[All Fields]) AND (dyspaghia[All Fields] OR ("deglutition"[MeSH Terms] OR "deglutition"[All Fields]) OR deglutitive[All Fields] OR ("deglutition"[MeSH Terms] OR "deglutition"[All Fields] OR "swallowing"[All Fields])) NOT "skinfold thickness"[All Fields] AND ("humans"[MeSH Terms] AND English[lang] AND ("infant"[MeSH Terms] OR "child"[MeSH Terms] OR "adolescent"[MeSH Terms])) ("Deglutition Disorders/diet therapy"[MeSH Terms] OR "Deglutition Disorders/therapy"[Mesh]) AND "Viscosity"[Mesh] (("Deglutition"[Mesh] OR "Deglutition Disorders"[Mesh] OR swallow* OR dysphagi* OR deglutiti*) AND ("Treatment Outcome"[Mesh] OR "Feeding Behavior"[Mesh])) MM = Major concept MH = Major Heading (MH "Impaired Swallowing (NANDA)") or (MH "Deglutition") or (MH "Deglutition Disorders") AND (cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR carobel OR hydra aid OR thick* OR thik OR consistenc* OR viscos*) (MH "Deglutition Disorders") AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil) ((MH "Dehydration") or (MH "Respiratory Tract Diseases+") or (MH "Aspiration") or (MH "Pneumonia, Aspiration") or (MH "Intestinal Diseases+") or (MH "Gastrointestinal Motility+") or (MH "Diarrhea") or (MH "Body Weight Changes+") or (MH "Colic+") or (MH "Growth Disorders+")) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil) (dysphagi* OR deglutition OR deglutitive OR swallow*) AND (physiol* OR efficiency OR liquid transfer OR aspiration OR aspirated OR feeding time) (dysphagi* OR deglutition OR deglutitive OR swallow*) AND (oral feed*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*)


(dysphagi* OR deglutition OR deglutitive OR swallow*) AND (weight OR growth OR thrive) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (dysphagi* OR deglutition OR deglutitive OR swallow*) AND (hydrat* OR dehydr* OR aspirat* OR bronchitis OR brochi*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (enterocolitis OR gut adhesion OR obstruction OR diarrhea OR aspirat* OR cough* OR colic OR weight OR thrive OR dehydrat*) AND (thick* OR thik*) DE = Subject term DE "DEGLUTITION disorders" AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (dysphagi* OR deglutition OR deglutitive OR swallow*) AND (physiol* OR efficiency OR liquid transfer OR aspiration OR aspirated OR feeding time) (dysphagi* OR deglutition OR deglutitive OR swallow*) AND (oral feed*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (dysphagi* OR deglutition OR deglutitive OR swallow*) AND (weight OR growth OR thrive) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (dysphagi* OR deglutition OR deglutitive OR swallow*) AND (hydrat* OR dehydr* OR aspirat* OR bronchitis OR brochi*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) DE "GASTROESOPHAGEAL reflux in children" AND (thick* OR thik*) (DE "DEGLUTITION DISORDERS IN CHILDREN" AND PT "ACADEMIC JOURNAL") OR (DE "DEGLUTITION DISORDERS IN CHILDREN --*" AND PT "ACADEMIC JOURNAL") (DE "Dysphagia" or DE "Feeding Disorders" or DE "Pharyngeal Disorders" or DE "Swallowing") AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR


carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (DE "Dysphagia" or DE "Feeding Disorders" or DE "Pharyngeal Disorders" or DE "Swallowing") AND (physiol* OR efficiency OR liquid transfer OR aspiration OR aspirated OR feeding time) (DE "Dysphagia" or DE "Feeding Disorders" or DE "Pharyngeal Disorders" or DE "Swallowing") AND (oral feed*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (DE "Dysphagia" or DE "Feeding Disorders" or DE "Pharyngeal Disorders" or DE "Swallowing") AND (weight OR growth OR thrive) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (DE "Dysphagia" or DE "Feeding Disorders" or DE "Pharyngeal Disorders" or DE "Swallowing") AND (hydrat* OR dehydr* OR aspirat* OR bronchitis OR brochi*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) DE = Descriptor ("dysphagia" or "swallowing" or "pediatric swallowing disorders" or "swallowing disorders") AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) DE="deglutition disorders diet therapy" ("dysphagia" or "swallowing" or "pediatric swallowing disorders" or "swallowing disorders") AND (physiol* OR efficiency OR liquid transfer OR aspiration OR aspirated OR feeding time) AND (DE=("infant newborn") or DE=("infant") or DE=("adolescent") and DE=("child") and DE=("child preschool")) ("dysphagia" or "swallowing" or "pediatric swallowing disorders" or "swallowing disorders") AND (oral feed*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) ("dysphagia" or "swallowing" or "pediatric swallowing disorders" or "swallowing disorders") AND (weight OR growth OR thrive) AND (thick* OR thik* OR carobel OR


hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) ("dysphagia" or "swallowing" or "pediatric swallowing disorders" or "swallowing disorders") AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) AND (DE=("infant newborn") or DE=("infant") or DE=("adolescent") and DE=("child") and DE=("child preschool")) DE="deglutition disorders therapy" AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) DE=("dysphagia" or "esophageal diseases") AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) ((enterocolitis OR gut adhesion OR obstruction OR diarrhea OR aspirat* OR cough* OR colic OR weight OR thrive OR dehydrat*) AND (thick* OR thik*)) and (DE=("children" or "adolescence" or "infants" or "juveniles" or "pediatrics")) (MeSH descriptor “Deglutition Disorders” explode all trees) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (MeSH descriptor “Deglutition Disorders” explode all trees) AND (physiol* OR efficiency OR liquid transfer OR aspiration OR aspirated OR feeding time) (MeSH descriptor “Deglutition Disorders” explode all trees) AND (oral feed*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (MeSH descriptor “Deglutition Disorders” explode all trees) AND (weight OR growth OR thrive) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (MeSH descriptor “Deglutition Disorders” explode all trees) AND (hydrat* OR dehydr* OR aspirat* OR bronchitis OR brochi*) AND (thick* OR thik* OR carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca OR consistenc* OR viscos*) (thickened liquid) OR thickener


Target area: Dysphagia Intervention: Swallowing/feeding intervention Keyword: Thickened liquids Keyword: Thickener (thickener OR thickened liquid) AND (infant* OR neonat* OR child* OR adolescen*) thickened [Words] and thickener [Words] Anywhere in Text: thickener thickened Title & Abstract only: infant toddler child adolescent adolescence Anywhere in Text: carobel hydra-aid enfamil Title & Abstract only: infant toddler child adolescent adolescence Anywhere in Text: cereal carob pectin cellulose rice gum Title & Abstract only: swallowing dysphagia deglutition Anywhere in Text: starch tapioca consistency viscosity Title & Abstract only: swallowing dysphagia deglutition Carobel Enfamil infant +(thick thickener thickened thik) +(dysphagia deglutitive deglutition swallowing) Enterocolitis Thickener hydra aid +thick (thickened OR thickener) AND (infant* OR neonat* OR child* OR adolescen*) AND (treatment OR therapy) AND (swallow* OR dysphag* OR degluti*) -rat -cat -lamb -dog -hamster -mouse (thick OR thickened OR thickener) AND (carobel OR hydra-aid OR enfamil OR cereal OR carob OR pectin OR cellulose OR rice OR gum OR cornstarch OR starch OR tapioca) AND (infant* OR neonat* OR child* OR adolescen*) AND (treatment OR therapy) AND (swallow* OR dysphag* OR degluti*) -rat -cat -lamb -dog -hamster -mouse

evidence-based systematic review: thickened liquids as a … · 2011-02-16 · asha's national...

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