One of my Pulmonology colleagues asked me, “Catherine, do you think it is worse to aspirate breastmilk or thickened formula?” My mind went so many directions… from relevant co-morbidities to overall clinical presentation, to history, to objective data about swallowing physiology from FEES, if there was bottle-feeding experience, and, if so, any comparative data about swallowing physiology…. and then to this latest evidence. The Pulmonologist and I had a wonderful discussion about the possible implications, and what we might take away from their results to inform our critical thinking and our practice.
Breastfeeding and bottle-feeding physiology have differences that, under certain conditions, may enhance airway protection at the breast — via the exquisite and protective swallow-breathe interface, which cannot be duplicated by a manmade nipple. We have no evidence that EBM via a manmade nipple will be as protective as EBM via mother’s breast, though it may offer a greater safety margin and less potential adverse effects than thickened formula. Perhaps more so in the setting of certain co-morbidities, or a unique infant. More data is needed to guide us, but this is certainly food for thought.
Hersh, C. J., Sorbo, J., Moreno, J. M., Hartnick, E., Fracchia, M. S., & Hartnick, C. J. (2022). Aspiration does not mean the end of a breast-feeding relationship. International Journal of Pediatric Otorhinolaryngology, 161, 111263.
ABSTRACT:
Objective: Breastfeeding is widely recommended as optimal nutrition for infants. However, there are no known publications on the impact of prandial aspiration of breast milk fed infants with dysphagia. The goal of this study was to assess pulmonary outcomes in infants with dysphagia who were given medical clearance for intake of
breast milk.
Methods: This retrospective cohort study included review of 80 infants examined between August 2016 to March 2021. Patients were evaluated by an interdisciplinary team of providers in a tertiary pediatric aerodigestive center. Patient inclusion criteria included a VFSS with documented aspiration or penetration with thin liquids. Participants met inclusion criteria if given medical clearance for intake of breast milk despite aspiration risk.
Pulmonary health was monitored for three months following medical clearance for the consumption of breast milk. Pulmonary illness was defined as development of bronchiolitis, wheezing, unexplained stridor during feeding, croup, pneumonia, or persistent bacterial bronchitis requiring medical intervention.
Results: Forty-three males (54%) and 37 females (46%) enrolled in the study with an age range of 1 month–6 months corrected age. Mean age at initial VFSS was 3.6 months. Twenty-six out of 80 (32.5%) had a report of a mild cough but did not require intervention. Eight out of 80 (10%) received a diagnosis of a pulmonary illness. Seventy-two out of 80 (90%) did not report pulmonary illness.
Conclusion: This pilot study reveals that the majority (90%) of this single institution, small sample size cohort of breast milk fed infants with documented oropharyngeal dysphagia remained healthy despite continued intake of breast milk. Prospective investigation is warranted to follow pulmonary health outcomes longitudinally and a head-to-head comparative study would be helpful to identify whether there were indeed significant changes to pulmonary health according to differential feeding regimens offered and followed.