Solid Meltables Made for Pediatric Feeding Challenges
Meltable Solids Made Specifically for People with Dysphagia
Over 2.3 million children under the age of 5 each year are affected by a pediatric feeding disorder (PFD). A PFD is defined as an impaired oral intake that is not age appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.
Current research shows that the prevalence of PFD is 1/37 children in the U.S. today. As a comparison 1/59 children are diagnosed with autism spectrum disorder (ASD). In fact, the majority of children with ASD also have PFD.
For infants and children with PFD, every bite of food can be painful, scary, or impossible, potentially impeding nutrition, development, growth, and overall well-being. Finding food that they are willing to eat and that are safe for them is the challenge for SLPs.
Although purée foods offer a nutritional solution, typical purée diets have been shown to contain up to 50% less protein than regular diets. (Vucea, 2017; Dahl, 2007) The goal to graduate individuals to firmer textures and expand their dietary options offers health, and psychosocial benefits that can’t be underestimated.
Transitional Foods – Where They Fit In?
Transitional food was coined by the International Dysphagia Diet Standardisation Initiative (IDDSI). It is defined as a food that rapidly changes texture in the presence of moisture or temperature change. (Cichero, 2017)
Given the special textural properties of these foods, minimal chewing is required, with tongue pressure often being sufficient to break the solid apart in the right environment.
Transitional foods can be divided into two categories: solid foam (ie. Cheeto Puffs, Veggie Stix) or solid gel/liquid (ie. ice cream). Solid foams are stable at room temperature and tend to remain so with increased temperature, but transition more so in the presence of moisture.
Traditionally, transitional foods are marketed to parents of toddlers as “first finger foods”. Why? Because they are rapidly dissolving in the mouth for safe swallowing and are easy to hold with a pincer grasp.
Awadalla et al., (2018) examined 9 commercially available first finger foods in the U.S. The results of this study showed that there was significant variability in dissolution in the mouth with only a small proportion meeting all the safety criteria specified by the American Academy of Pediatrics. Of even greater concern was that leaving the foods exposed to air led to some test samples becoming as hard as candy.
Michelle Dawson CCC-SLP, host of “The First Bite” shared with me:
“First finger foods are designed for the typically developing child who is between 6-9 months and has reached the appropriate developmental "Food Age", and is learning to transition between a phasic bite to a vertical chew pattern, or maybe even moving into a transitional chew pattern (vertical chew meets lateralization ability with the tongue). But that is not viable for our kiddos with a PFD.”
However, the importance of rapidly dissolvable solid foods for PFD remains. These foods can support tube feed weaning, reduce texture aversions and graduate children from purées to solids. The need for improvement lies in better safety results, improved nutritional value, and more natural flavors that help children appreciate healthy food tastes.
Enter Savorease Therapeutic Foods
Savorease Therapeutic foods were developed over the past several years to answer cravings for crunchy foods for adults with dysphagia. It was discovered that Savorease Crispy Melts™ are a new favorite for children with PFD as well.
The crisps give a satisfying crunchy texture but melt away in seconds. They come in sweet carrot, snap pea and chicken flavors and have added plant protein without the sugar!
Evidence was published in Dysphagia Journal this year (Barewal, R., 2020) on the superior dissolve rate of the crackers as compared to other transitional foods such as Baby Mum Mums, shrimp chips and the Eat bar. IDDSI testing demonstrates the Crispy Melts dissolve to level 4 puree consistency. \
A recent study (Ross, C.,2020) shows that children with Down Syndrome actually prefer a crispy dissolvable texture. Having a product that won’t stick to their palate and elicit gagging is finally here.
Crispy Melts come with protein enriched dips that are a puree consistency and give a child the pleasure of a finger food that can be dipped - inspiring confidence in a new self-feeder.
Currently used in therapy sessions with SLPs but now also available for parents to have on hand at home at www.savorease.com. Savorease will help families promote chewing, increase quality of snack time and offer their child real food flavors that they enjoy.
Dawson says, “I now have a crisp that will safely and effectively meet the needs of my patients so we can progress their "Food Age" to align with their developmental abilities...all while bringing joy and laughter back to the patient and their family...because at the end of the day eating is fun and should be celebrated.”
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- Vucea, V., Keller, H. H., Morrison, J. M., Duncan, A. M., Duizer, L. M., Carrier, N., et al., (2017). Nutritional quality of regular and pureed menus in Canadian long term care homes: An analysis of the Making the Most of Mealtimes (M3) project. BMC Nutrition, 3(1), 80.
- Dahl, W. J., Whiting, S. J., & Tyler, R. T. (2007). Protein content of pureed diets: Implications for planning.Canadian Journal of Dietetic Practice and Research, 68(2), 99-102.
- Cichero, J., Lam, P., Steele, C.M., Hanson, B., Chen, J., Dantas, R.O., et al., (2017). Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia 32; 293-314.
- Awadalla, M.D., Pham, T., Milanaik, R. (2018). Chew on This: Not all First Finger Foods Foods are Created Equal. Clinical Pediatrics. 57(8); 889-894.
- Barewal, R., Shune, S., Ball, J., Kosty, D. (2020). A comparison of behavior of transitional-state foods under varying oral conditions. Dysphagia. Advanced online publication.
- Ross, C.F., Surette, V.A., Smith-Simpson, S., Bernhard, C.B., Wakeling, I., & Hasted, A. Food texture preferences of children with Down syndrome as determined using a home-use test. J. Texture Stud. (in review).