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Ascorbic acid, folic acid, and citric acid may be added to shelf stable foods to preserve them and reduce the risk of bacteria. The hidden dilemma is that while shelf-stable baby foods like apple sauce may be a quick and easy way to thicken liquids to a safe consistency, they can have very high acid contents. It could be theorized that pureed foods are more natural than commercial thickening options and may provide additional nutritional value to a child’s diet. Over the last several years, there has been an increase in the practice of using pureed foods to thicken liquids for children who are aspirating thinner viscosities. Hidden Acidity of Naturally Thickened Liquids The benefits and limitations of using each type of thickener are listed in Table 1 below. Thickening liquids in the pediatric population can be challenging due to several factors. The primary thickening agents used in the pediatric population include starch-based thickeners (e.g., corn starch), gum-based thickened (e.g., Xanthan or Carbo gum), infant cereals (e.g., rice or oatmeal), and the use of food purees. Adjusting the feeding method or equipment, utilizing feeding and swallowing strategies, and offering thickened liquids are the primary tools available to improve oral feeding safety.

When infants and children aspirate liquids there are few options available to optimize their safety while being mindful of nutritional needs.