What is Thick Water and When is It Prescribed?
Thick water is regular water with a commercial or natural thickening agent added to increase its viscosity. This modification is done for a specific medical reason: to help children with dysphagia (swallowing difficulties) manage liquids safely. When a child has dysphagia, thin liquids like water can move too quickly down the throat, increasing the risk of aspiration. Aspiration occurs when fluid enters the airway and potentially the lungs, which can lead to serious respiratory issues, including pneumonia.
A speech-language pathologist (SLP) performs a comprehensive evaluation to determine if thickened liquids are needed. The SLP will also specify the exact level of thickness required based on a standardized scale, such as the International Dysphagia Diet Standardisation Initiative (IDDSI). Thickened liquids move more slowly, giving the child more time to control the liquid in their mouth and coordinate the swallow reflex effectively.
The Crucial Role of Professional Medical Guidance
It is imperative that thick water is not given to a child without a medical professional's assessment and recommendation. Unnecessary thickening can cause its own set of problems, and the wrong consistency could still pose a risk. The specific thickener used and the level of thickness prescribed are not a matter of guesswork; they are critical medical decisions tailored to the child's specific needs.
Why thick water is not for general consumption
- Hydration risks: Thick water's altered taste and texture can lead to decreased fluid intake, potentially causing dehydration.
- Developmental impact: For children who do not have a swallowing disorder, thick water can impede the development of normal oral motor skills and delay progress to age-appropriate textures.
- Gastrointestinal issues: Some thickeners, particularly starch-based ones, can cause gastrointestinal side effects like constipation or early satiety, which is especially problematic for growing infants and toddlers.
Benefits and Risks of Thick Water for Children with Dysphagia
Benefits of thickened fluids
- Reduces aspiration risk: By slowing the liquid's flow, thick water significantly lowers the chances of liquid entering the lungs, preventing potentially life-threatening respiratory infections.
- Improved oral control: The thicker consistency provides better sensory input, helping a child control the liquid bolus in their mouth and throat.
- Enables hydration: For children who would otherwise struggle to drink enough thin liquids, thick water allows them to stay hydrated safely.
Potential risks and considerations
- Dehydration: As mentioned, children may drink less thickened liquid due to the texture, taste, or a feeling of early fullness, which increases the risk of dehydration.
- Altered taste and texture: Many thickeners change the liquid's flavor and mouthfeel, which can lead to poor palatability and reduced intake.
- Nutritional concerns: Thickened liquids can increase the feeling of fullness, potentially reducing overall caloric intake for children who need to gain weight. This must be monitored by a dietitian.
- Gastrointestinal issues: Constipation and early satiety are documented side effects, especially with starch-based products.
- Increased residue: In some cases, thickened liquids can leave more residue in the pharynx, which could theoretically be aspirated later.
Commercial vs. Natural Thickeners: A Comparison
When a child is prescribed thickened fluids, a doctor or SLP will recommend a specific type of thickener. Here is a comparison of common options:
| Feature | Commercial Thickeners | Natural Thickeners (e.g., pureed foods) |
|---|---|---|
| Types | Starch-based (corn, potato), Gum-based (xanthan gum) | Infant cereal, fruit/vegetable purees (e.g., banana flakes) |
| Consistency | Consistent and stable if mixed correctly. Gum-based are more stable over time. | Can vary, may thin out over time or with temperature. |
| Infant Use | Starch-based or infant cereal often recommended for infants under 12 months. Specific thickeners like xanthan gum are contraindicated for infants due to NEC risk. | May introduce additional nutrients, requiring dietitian oversight to prevent nutritional displacement. |
| Taste | Can alter the taste, sometimes metallic or grainy. | Adds the flavor of the pureed food, which may be more palatable for some children. |
| Mixing | Requires careful measurement to achieve the prescribed thickness, following manufacturer instructions. | Less precise, consistency can be harder to control. |
| Availability | Widely available in pharmacies and online. | Easily available with common kitchen ingredients. |
Safely Administering Thick Water
When a healthcare professional prescribes thickened liquids, parents and caregivers must follow instructions precisely. This ensures the fluid is effective and safe. Key steps include:
- Use appropriate equipment: A different nipple might be necessary for bottles to accommodate the thicker liquid. Consult with your SLP or OT before making any changes.
- Measure accurately: Use the specific measuring tools provided or instructed by your healthcare team. Kitchen spoons are not accurate and can lead to incorrect consistency.
- Follow instructions: Adhere to the manufacturer's directions for mixing the thickener. Improper mixing can leave lumps that are a choking hazard.
- Stir thoroughly: Ensure the thickener is fully dissolved to prevent a lumpy or inconsistent texture.
- Monitor your child: Watch for signs of distress during feeding, including coughing, choking, or changes in breathing. Also, monitor for signs of dehydration, such as fewer wet diapers or irritability.
Alternatives to Thickened Fluids
For some children, especially those with mild swallowing issues, alternative strategies may be effective and preferable. A speech pathologist can recommend the best course of action. These alternatives might include:
- Positional changes: Adjusting a child's position during feeding can help improve swallowing mechanics.
- Pacing: This technique involves controlling the rate of flow during feeding to allow the child more time to swallow.
- Therapeutic exercises: Oral-motor exercises can help strengthen the muscles involved in swallowing over time, potentially reducing or eliminating the need for thickeners.
- Free water protocol: For carefully selected patients, some protocols allow access to thin water between meals after thorough oral care.
Ultimately, the decision to use thickened water is a medical one. For more information on pediatric feeding and swallowing disorders, please visit the Royal College of Speech and Language Therapists website.
Conclusion
Thick water is a specific medical tool for children with diagnosed dysphagia, used to reduce the risk of aspiration and improve swallowing safety. It is not intended for recreational or unprescribed use due to potential risks like dehydration and negative impacts on feeding experiences. Any decision to use thickened liquids must be made in consultation with a healthcare professional, such as a speech-language pathologist, who will determine the appropriate type and consistency based on a thorough assessment. Parents must adhere to precise instructions for preparation and administration and monitor their child for any adverse effects. For many children, there are also alternative strategies that a specialist can recommend to address swallowing issues safely.
