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RecruitingNCT04504227Updated Mar 18, 2026

Effect of Thickened Feeds on Swallow Physiology in Children With Dysphagia

An interventional study of Thin liquid swallows and Slightly thickened liquid swallows in Dysphagia, Aspiration and Brief Resolved Unexplained Event (BRUE), sponsored by Boston Children's Hospital. Recruiting at 1 site in United States. Open to participants aged Up to 21 Years. Per ClinicalTrials.gov, last updated 2026-03-18.

Sponsored by Boston Children's Hospital · Not applicable, Interventional, and Diagnostic

Phase
Not applicable
Study type
Interventional
Enrollment
200
Allocation
Randomized
Ages
Up to 21 Years
Sex
All
01

Study summary

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.

Read the detailed description

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.

02

Conditions studied

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

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03

Who can participate

Ages eligible
Up to 21 Years
Sexes eligible
All
Accepts healthy volunteers
No

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

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
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Study design

Phase
Not applicable
Primary purpose
Diagnostic
Allocation
Randomized
Intervention model
Crossover assignment
Masking
Single (Investigator)
Enrollment
200 participants (estimated)

Study arms

  • Placebo comparator
    Thin liquid swallows

    Thin liquid swallows of formula or breastmilk or other liquid

    Dietary Supplement: Thin liquid swallows

  • Experimental
    Slightly thick liquid swallows

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

    Dietary Supplement: Slightly thickened liquid swallows

  • Experimental
    Mildly thick liquid swallows

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

    Dietary Supplement: Mildly thickened liquid swallows

  • Experimental
    Moderately thick liquid swallows

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

    Dietary Supplement: Moderately thickened liquid swallows

Interventions

  • Dietary supplementThin liquid swallows

    Thin liquid swallows of formula or breastmilk or other liquid

  • Dietary supplementSlightly thickened liquid swallows

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

  • Dietary supplementMildly thickened liquid swallows

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

  • Dietary supplementModerately thickened liquid swallows

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

05

What researchers measure

Primary outcomes

  1. Swallow risk indices for thin vs mildly thick vs slightly thick liquids

    We will calculate swallow risk index (SRI) from impedance-manometry results to compare mean SRI with thin liquids and thickened liquids for subjects with aspiration compared to mean SRI for thin liquids and thickened liquids in subjects without aspiration.

    Time frame: 30 minutes

Secondary outcomes

  1. Impedance-Manometry Swallow Physiology Metrics

    We will measure swallow physiology metrics from impedance-manometry results, including post-swallow impedance ratio, to compare these parameters with thin liquids between subjects with and without aspiration and with varied liquid consistencies within subjects.

    Time frame: 30 minutes

06

Study locations

1 of 1 sites recruiting
07

References and documents

Publications

  • 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. PubMed 27741062 ↗
  • 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. PubMed 31098722 ↗
  • 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. PubMed 31103259 ↗
  • 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. PubMed 24552674 ↗
  • 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. PubMed 21556039 ↗
  • 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. PubMed 36336644 ↗
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Registry details

Key details

Study ID
NCT04504227
Lead sponsor
Boston Children's Hospital
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Responsible party
Daniel Duncan (Assistant Professor of Pediatrics, Boston Children's Hospital) — Principal investigator
First posted
Aug 7, 2020
Start date
Apr 1, 2021
Primary completion
Aug 31, 2026 (estimated)
Completion
Aug 31, 2026 (estimated)
Last update
Mar 18, 2026

Study contacts

Daniel R Duncan, MD, MPH
Contact
daniel.duncan@childrens.harvard.edu
617-355-0897
Daniel R Duncan, MD, MPH
principal investigator · Boston Children's Hospital
Rachel Rosen, MD, MPH
study director · Boston Children's Hospital
Sudarshan Jadcherla, MD
study director · Nationwide Children's Hospital
Taher Omari, PhD
study director · Flinders University
Samuel Nurko, MD, MPH
study director · Boston Children's Hospital

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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