Henry is an ex-24 week, now nearly term infant who has been receiving therapy services since he was very small. You spent weeks ensuring that he was cared for in a neurodevelopmentally supportive way, worked closely with his family, and provided developmentally appropriate pre-feeding experiences. However, his transition to bottle feeding has been difficult, and he continues to struggle. Despite following his cues closely, determining the most appropriate nipple flow rate, trialing various positioning strategies, utilizing pacing techniques, and implementing all of your other usual strategies, you still suspect that there is some degree of airway compromise with feeding. Henry receives breastmilk exclusively, and thickening his diet is not an option.
Despite having many effective strategies in our therapy “bag of tricks”, we can often feel stuck when feeding babies like Henry. We are sometimes left wishing that some additional strategies used in the adult population could be used for infants. One such strategy that is commonly used for adults with dysphagia is feeding with cold liquids. The theory behind this strategy is that the cold temperature provides an additional sensory cue to stimulate a timelier, safer swallow.
A pilot study published in 2018 sought to determine the short-term effects of cold liquids on the pharyngeal swallow in preterm infants with dysphagia. This study included 9 preterm infants who demonstrated clinical symptoms of dysphagia. These babies underwent video fluoroscopic swallow study (VFSS) with thin barium at room temperature using the nipple flow rate they had been using bedside. Researchers found that all nine infants demonstrated pharyngeal phase dysphagia with the room temperature liquid. Each participant was then fed with cold temperature barium (4-9 ◦C) one minute after their initial VFSS. After statistical analysis researchers found that the occurrence of deep penetration (barium in the laryngeal vestibule to the level of the vocal folds) and tracheal aspiration decreased significantly under the cold liquids (barium) condition versus with room temperature liquids (barium). There was also a trend of less nasopharyngeal reflux with cold liquids.
The researchers note that this is a pilot study, and further studies will need to be conducted before feeding preterm infants with cold liquids can be recommended for regular use in clinical practice. A study that looks at longer term effects of cold liquids can further demonstrate safety of cold feedings (in terms of potential for cold stress in infants) and efficacy (whether or not there is a habituation effect at a certain point during a cold feeding). The results of this study are, nevertheless, very exciting as they provided a basis for future studies, and offer new possibilities for advancement of our profession in helping at risk infants feed safely.
Ferrara, L., Kamity, R., Islam, S., Sher, I., Barlev, D., Wennerholm, L., et al. (2018) Short-term effects of cold liquids on the pharyngeal swallow in preterm infants: A pilot study. Dysphagia, 33, 593-601.
Abstract and link to full text article available at: https://link.springer.com/article/10.1007/s00455-018-9877-8