Healthy Children Like and Ingest an Amino Acid-Fortified Oral Rehydration Solution With Added Sweetener, Flavor, and Color: A Psychophysical Study

Abstract

Increasing acceptance of bitter stimuli is important for the health of pediatric patients who must consume bitter medicines or nutritional interventions. The aim of this study was to determine if children age 6 months to 5 years accept an amino acid (AA)-supplemented oral rehydration therapy (ORT) that contains multiple bitter tasting AAs. These AAs can be clinically advantageous to the gastrointestinal tract, which could benefit children during acute diarrhea, but no research has shown that children will accept and ingest this novel formulation. Sodium gluconate, sucralose, strawberry flavor, and pink color were used to decrease bitterness and increase palatability. Participants were taught how to play “The Tasting Game” in which they gave the solutions they liked to a plush toy of Big Bird_TM and those they did not like to a plush toy of Oscar the Grouch_TM. Participants were filmed during the sessions and their facial expressions were analyzed. Participants were offered the solutions to drink and the volume consumed was also measured. The addition of sodium gluconate, color, or flavor as individual additives did not significantly increase acceptance of the AA-based ORT. Sucralose increased acceptance in comparison to quinine but was still less accepted than sucrose. Sucralose in combination with strawberry flavor was significantly more liked than quinine and not significantly less than sucrose. Sucralose, strawberry flavor, and pink color in combination was the most liked solution. The most positive facial reactions were expressed in response to this solution as well. Participants drank and tolerated up to 80 mL of the sucralose-sweetened, strawberry-flavored, and pink-colored amino acid-based formulation in one 15 min sitting. This study demonstrates that pediatric participants will accept a novel bitter-reduced AA-based formulation of oral rehydration therapy with sucralose, strawberry flavor, and pink color added.