All purees are not created equal: thickness, adhesiveness, and cohesiveness of commercially available first foods
The purpose of this study was to investigate the thickness, cohesiveness, and adhesiveness of foods typically consumed as feeding skills develop in the first year of life. The subjective feeding difficulty levels 1-4, presented by Gerber and Beech-Nut, were examined with the International Dysphagia Diet Standardization Initiative (IDDSI) drip test, spoon tilt test, and fork pressure test to determine the thickness, cohesiveness, and adhesiveness of the foods offered at each of the four levels. The drip test, which measures overall thickness, was conducted by recording the amount of liquid that drips out of a 10-mL syringe after 10 seconds. The spoon tilt test, which evaluates cohesiveness and adhesiveness, was performed by tilting a sample of purée in a spoon and assessing the state of the sample as it slides off. Lastly, the fork pressure test utilized a standard metal fork to apply pressure to food samples to determine if particles are safe to swallow. The results of this study concluded that thickness, cohesiveness, and adhesiveness are not impacted by brand, marketed stage (levels 1-4), or packaging. However, this study did establish that food packaged in pouches are slightly less adhesive than food packaged in jars. This finding indicates that food in pouches require less oral motor skill to swallow. The results signify that the proposed levels of baby food are not based on a hierarchy of difficulty but are instead for marketing purposes. The results also concluded that the texture of food was not impacted by the use of “natural ingredients.” The difficulty level of each food was determined and mapped to the IDDSI framework to provide guidance on the developmental appropriateness of each “starter food” for use by clinicians treating pediatric patients with dysphagia.