The Importance of Thickened Fluids for Dysphagia
Dysphagia, or difficulty swallowing, is a condition that affects millions of people and can significantly increase the risk of aspiration. Aspiration occurs when food or liquid enters the airway and lungs, potentially leading to serious complications like pneumonia. Thickened fluids move more slowly in the mouth and throat, giving the individual more time to control the liquid and safely swallow. An assessment by a speech and language therapist (SLT) or dietitian is crucial to determine the appropriate thickness level for each person. The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a globally recognized framework for standardizing liquid thickness levels, promoting safer consumption.
Types of Thickeners
There are several options for thickening liquids, each with its own properties and best uses. The choice of thickener often depends on individual needs, preferences, and the type of liquid being prepared.
- Commercial Thickening Powders: These are the most common and widely available thickeners, such as Thick-It, ThickenUp, and Nutilis. They are typically starch-based or gum-based (like xanthan gum) and come with specific mixing instructions for different thickness levels. Gum-based thickeners, like SimplyThick, tend to be clearer and less prone to clumping.
- Commercial Gel Thickeners: These come in a gel form and can be mixed into liquids without clumping. SimplyThick is a popular brand that offers a gel option. Gel thickeners are often easier and faster to mix, making them a convenient choice.
- Natural Thickeners: For some foods and liquids, household ingredients can be used. These might include baby rice cereal, instant potato flakes, pureed fruits, or cornstarch. Natural thickeners are generally not recommended for everyday use in drinks like water or juice, as they can alter the taste and texture significantly.
Step-by-Step Instructions to Prepare Thickened Fluids
Always follow the specific instructions on the thickener packaging, as proportions and mixing times can vary between brands. The following is a general guide to preparing a single serving of thickened fluid.
- Gather Your Supplies: You will need the liquid, the prescribed thickener, a measuring scoop (usually provided with commercial thickeners), and a fork or whisk for mixing.
- Add Thickener to a Dry Cup: Place the required number of level scoops of thickener powder into a clean, dry cup before adding the liquid. This prevents the thickener from sticking to the cup and forming lumps.
- Pour in the Liquid: Pour the measured amount of liquid over the powder. For hot drinks, allow them to cool slightly before adding the thickener. For milky drinks, whisk the milk first to break up fat particles. Carbonated drinks should be stirred to disperse bubbles before thickening.
- Stir Briskly: Stir the mixture immediately and vigorously with a fork or whisk for at least 30 seconds. Do not use the measuring scoop for stirring. For larger batches, a blender on a low-speed setting is effective but be careful not to over-blend and introduce too many air bubbles.
- Wait for Thicken Time: Allow the fluid to stand for the time recommended on the packaging, typically 1 to 5 minutes. The liquid will continue to thicken during this period. Do not add more thickener during this time, as it can result in an overly thick and unsafe consistency.
- Test the Consistency: Use the IDDSI Flow Test or a fork/spoon test to confirm the liquid is at the correct thickness level, as recommended by the SLT.
- Serve and Monitor: Serve the drink to the individual, ensuring they are sitting upright. If the drink is not consumed immediately, stir again before serving. Dispose of any prepared drinks that have been stored for more than 24 hours.
The International Dysphagia Diet Standardisation Initiative (IDDSI) Framework
The IDDSI framework provides clear and standardized descriptions for different liquid and food consistencies. Your healthcare professional will prescribe a specific IDDSI level based on your swallowing assessment.
| IDDSI Level | Name | Description | Test Method |
|---|---|---|---|
| Level 0 | Thin | Flows like water; can be sipped through a straw. | No liquid remaining in a 10ml syringe after 10 seconds. |
| Level 1 | Slightly Thick | Thicker than water, but still easily pourable; can be sipped through a straw with some effort. | 1-4ml of liquid remains in a 10ml syringe after 10 seconds. |
| Level 2 | Mildly Thick | Flows more slowly; can be sipped from a cup but requires effort with a straw. | 4-8ml of liquid remains in a 10ml syringe after 10 seconds. |
| Level 3 | Moderately Thick | Drips slowly from a spoon in dollops; can be eaten with a spoon or drunk from a cup. | 8-10ml of liquid remains in a 10ml syringe after 10 seconds. |
| Level 4 | Extremely Thick | Holds its shape on a spoon and does not pour; must be eaten with a spoon. | All 10ml of liquid remains in a syringe after 10 seconds, with no drips. |
For more detailed information on testing methods and the complete IDDSI framework, visit the official IDDSI website.
Nutritional Considerations and Safety Precautions
Individuals who rely on thickened fluids are at a higher risk of dehydration because the altered texture can decrease a person’s desire to drink. It is important to monitor fluid intake and encourage regular sips throughout the day, not just at mealtimes. High-protein, high-energy fluids like milk, juice, or nutritional supplement drinks are excellent choices to support nutritional needs.
Key Safety Precautions
- Never Add Thickener to Melty Foods: Avoid thickening foods that become thin liquids at room temperature, such as ice cream, popsicles, or gelatin. These melt into a thin consistency that cannot be safely thickened.
- Avoid Mixed Consistencies: Do not serve foods with a combination of thin and solid parts, like soup with noodles or fruit cocktail in juice, unless they are pureed and thickened.
- Store Properly: If preparing a large batch, store it in the refrigerator in a covered container and re-stir it before each use.
- Check Temperature: Hot thickened fluids can retain heat and cause burns, so always allow them to cool slightly before adding thickener and serving.
- Tablet Medications: Do not take medications in tablet form with thickened fluids unless advised by a healthcare professional. A pharmacist can advise on safe alternatives or methods.
Conclusion
Knowing how to prepare thickened fluids correctly is a vital skill for caregivers managing dysphagia. By understanding the different types of thickeners, following proper preparation techniques, and adhering to standardized consistency levels like the IDDSI framework, you can ensure a safer and more comfortable experience for the individual. Regular monitoring of hydration and nutritional intake is also essential. Always consult with a speech and language therapist or dietitian to receive personalized advice and training for the individual's specific needs.
