Effect of Thickened Feeds on Swallow Physiology in Children With Dysphagia

NCT ID: NCT04504227

Last Updated: 2025-12-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-01

Study Completion Date

2026-08-31

Brief Summary

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This study will examine the effects of varying liquid viscosity on swallow physiology in infants with oropharyngeal dysphagia and brief resolved unexplained event (BRUE) and other children with dysphagia that would be at risk for symptoms of swallow dysfunction.

Detailed Description

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Infants with oropharyngeal dysphagia and in particular brief resolved unexplained events (BRUE) are a significant driver of pediatric health care expenditure since the mechanism for their swallow dysfunction is incompletely understood and therefore frequently goes unrecognized and untreated. We hypothesize that infants with oropharyngeal dysphagia and BRUE have measurable differences in swallowing physiology to explain their symptoms of cyanotic choking spells, that these differences can be quantified using pharyngeal high resolution impedance-manometry compared to videofluoroscopic swallow study results, and that this swallowing dysfunction can be safely corrected with a change of formula viscosity. Through this research project, we will systematically investigate the effects of thickened feedings on swallow function in infants with dysphagia and BRUE and perform detailed physiology studies on pharyngeal and esophageal motility as critical mediators of improved outcomes.

Conditions

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Dysphagia Aspiration Brief Resolved Unexplained Event (BRUE) Apparent Life Threatening Event (ALTE)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

4-test consistency, randomized, crossover, single-blinded swallow physiology study comparing effects of different liquid viscosities on swallow coordination in infants and children
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Investigators

Study Groups

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Thin liquid swallows

Thin liquid swallows of formula or breastmilk or other liquid

Group Type PLACEBO_COMPARATOR

Thin liquid swallows

Intervention Type DIETARY_SUPPLEMENT

Thin liquid swallows of formula or breastmilk or other liquid

Slightly thick liquid swallows

Slightly thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Group Type EXPERIMENTAL

Slightly thickened liquid swallows

Intervention Type DIETARY_SUPPLEMENT

Slightly thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Mildly thick liquid swallows

Mildly thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Group Type EXPERIMENTAL

Mildly thickened liquid swallows

Intervention Type DIETARY_SUPPLEMENT

Mildly thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Moderately thick liquid swallows

Moderately thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Group Type EXPERIMENTAL

Moderately thickened liquid swallows

Intervention Type DIETARY_SUPPLEMENT

Moderately thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Interventions

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Thin liquid swallows

Thin liquid swallows of formula or breastmilk or other liquid

Intervention Type DIETARY_SUPPLEMENT

Slightly thickened liquid swallows

Slightly thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Intervention Type DIETARY_SUPPLEMENT

Mildly thickened liquid swallows

Mildly thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Intervention Type DIETARY_SUPPLEMENT

Moderately thickened liquid swallows

Moderately thick liquid swallows of formula thickened with rice cereal or breastmilk or other liquid thickened with Gelmix

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Age 0 to 21 years
* Admitted to Boston Children's Hospital after experiencing first lifetime BRUE, or with dysphagia symptoms such that they would be at risk for BRUE or other symptoms of swallowing difficulty
* Have had videofluoroscopic swallow study performed or might have future videofluoroscopic swallow study performed.

Exclusion Criteria

* Any pre-existing medical diagnoses that exclude brief resolved unexplained event diagnosis including seizure disorders and cyanotic congenital heart disease
* Any nasal/pharyngeal/esophageal anomalies that might affect safe placement of the pharyngeal motility catheter
* Children fed exclusively by enteral tube
* Allergy to rice cereal or Gelmix thickener, which will be used to adjust liquid viscosity
Maximum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

Boston Children's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Daniel Duncan

Assistant Professor of Pediatrics

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Daniel R Duncan, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Boston Children's Hospital

Rachel Rosen, MD, MPH

Role: STUDY_DIRECTOR

Boston Children's Hospital

Sudarshan Jadcherla, MD

Role: STUDY_DIRECTOR

Nationwide Children's Hospital

Taher Omari, PhD

Role: STUDY_DIRECTOR

Flinders University

Samuel Nurko, MD, MPH

Role: STUDY_DIRECTOR

Boston Children's Hospital

Locations

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Boston Children's Hospital

Boston, Massachusetts, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Daniel R Duncan, MD, MPH

Role: CONTACT

617-355-0897

Facility Contacts

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Daniel R Duncan, MD, MPH

Role: primary

6173550897

References

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Duncan DR, Amirault J, Mitchell PD, Larson K, Rosen RL. Oropharyngeal Dysphagia Is Strongly Correlated With Apparent Life-Threatening Events. J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):168-172. doi: 10.1097/MPG.0000000000001439.

Reference Type BACKGROUND
PMID: 27741062 (View on PubMed)

Duncan DR, Larson K, Rosen RL. Clinical Aspects of Thickeners for Pediatric Gastroesophageal Reflux and Oropharyngeal Dysphagia. Curr Gastroenterol Rep. 2019 May 16;21(7):30. doi: 10.1007/s11894-019-0697-2.

Reference Type BACKGROUND
PMID: 31098722 (View on PubMed)

Duncan DR, Growdon AS, Liu E, Larson K, Gonzalez M, Norris K, Rosen RL. The Impact of the American Academy of Pediatrics Brief Resolved Unexplained Event Guidelines on Gastrointestinal Testing and Prescribing Practices. J Pediatr. 2019 Aug;211:112-119.e4. doi: 10.1016/j.jpeds.2019.04.007. Epub 2019 May 15.

Reference Type BACKGROUND
PMID: 31103259 (View on PubMed)

Rommel N, Selleslagh M, Hoffman I, Smet MH, Davidson G, Tack J, Omari TI. Objective assessment of swallow function in children with suspected aspiration using pharyngeal automated impedance manometry. J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):789-94. doi: 10.1097/MPG.0000000000000337.

Reference Type BACKGROUND
PMID: 24552674 (View on PubMed)

Omari TI, Dejaeger E, Van Beckevoort D, Goeleven A, De Cock P, Hoffman I, Smet MH, Davidson GP, Tack J, Rommel N. A novel method for the nonradiological assessment of ineffective swallowing. Am J Gastroenterol. 2011 Oct;106(10):1796-802. doi: 10.1038/ajg.2011.143. Epub 2011 May 10.

Reference Type BACKGROUND
PMID: 21556039 (View on PubMed)

Duncan DR, Liu E, Growdon AS, Larson K, Rosen RL. A Prospective Study of Brief Resolved Unexplained Events: Risk Factors for Persistent Symptoms. Hosp Pediatr. 2022 Dec 1;12(12):1030-1043. doi: 10.1542/hpeds.2022-006550.

Reference Type BACKGROUND
PMID: 36336644 (View on PubMed)

Other Identifiers

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K23DK127251

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IRB-P00036103

Identifier Type: -

Identifier Source: org_study_id

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