What is IDDSI Level 2: Mildly Thick?
The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a globally recognized framework for standardizing food and liquid textures for people with dysphagia, or swallowing difficulties. Within this framework, Level 2 is the formal classification for mildly thick liquids. Previously known as 'nectar-thick,' this consistency is a crucial step between slightly thickened and moderately thickened liquids. Its purpose is to provide a safer drinking experience for individuals whose swallowing reflexes may be delayed or impaired, allowing more time to control the liquid.
Characteristics of Mildly Thick Liquids
IDDSI Level 2 liquids have specific, observable characteristics that distinguish them from other consistencies. These include:
- Pourable: They pour quickly from a spoon but more slowly than thin liquids like water.
- Sippable: They can be sipped from a cup, but some effort is required to drink them through a standard bore straw.
- Appearance: When observed on a spoon, a mildly thick liquid will run off, but a thin coating may be left behind. It does not hold its shape like a thicker liquid or puree.
- Texture: The liquid should be completely smooth, with no lumps or particles.
The Importance of Mildly Thick Liquids for Dysphagia Management
For people with dysphagia, swallowing thin liquids can pose a significant risk of aspiration, where fluid enters the airway instead of the esophagus. Mildly thick liquids are prescribed by a speech pathologist to mitigate this risk. By slowing the flow rate of the liquid, it gives the individual more time to coordinate their swallow, thereby reducing the chances of coughing, choking, or developing aspiration pneumonia.
Commonly used liquids that may be or can be thickened to a Level 2 consistency include:
- Milkshakes and smoothies
- Some fruit nectars
- Thickened water, juice, or coffee made with thickening powder or gel
How to Test for IDDSI Level 2 (Mildly Thick)
The IDDSI Flow Test is the recommended objective method for confirming the consistency of thickened liquids. This process uses a standard 10mL syringe and a 10-second flow time to determine the IDDSI level accurately.
Steps for the IDDSI Flow Test:
- Preparation: Place the tip of a 10mL Luer-Lock syringe over a finger to stop the hole at the bottom. Ensure the plunger is removed.
- Filling: Pour the liquid to be tested into the syringe up to the 10mL line.
- Flow: Remove your finger and allow the liquid to flow out for exactly 10 seconds. Use a timer to be precise.
- Measurement: Immediately after 10 seconds, place your finger back over the tip and measure how much liquid remains in the syringe.
- Result: For a Level 2 (Mildly Thick) liquid, the remaining volume should be between 4mL and 8mL.
IDDSI Fluid Levels: A Comparison Table
Understanding the subtle differences between the various liquid levels is key to safe dysphagia management. Below is a comparison of IDDSI fluid levels from thin to extremely thick.
| Feature | Level 0: Thin | Level 1: Slightly Thick | Level 2: Mildly Thick | Level 3: Moderately Thick |
|---|---|---|---|---|
| Flow Rate | Flows like water | Flows slightly slower than water | Pours quickly from a spoon, slower than thin liquids | Drips slowly in dollops from a spoon |
| Syringe Flow Test (10s) | <1 mL remaining | 1-4 mL remaining | 4-8 mL remaining | >8 mL remaining |
| Straw Use | Easy to drink through a straw | Some effort needed | Mild effort needed | Cannot be sucked through a straw |
| Examples | Water, juice, coffee | Tomato juice, melted ice cream | Milkshakes, some smoothies, thickened beverages | Liquidized foods, thick yogurt |
| Clinical Use | For normal swallowing function | For minimal swallowing difficulty | For difficulty with thin and slightly thick liquids | For significant swallowing difficulty |
How a Clinical Team Determines the Correct Level
A speech pathologist is the key healthcare professional responsible for conducting a comprehensive swallowing assessment and recommending the appropriate fluid and food consistency for an individual with dysphagia. They use clinical judgment alongside observable signs of swallowing problems, such as coughing, choking, or a gurgling voice after drinking.
Furthermore, it is crucial to re-evaluate the recommended level regularly, as swallowing ability can change over time due to a person's condition or recovery. Factors such as the individual's hydration status, medical history, and overall well-being are also taken into consideration when making a personalized recommendation.
Conclusion
Yes, IDDSI Level 2 is officially and consistently classified as 'mildly thick' within the international framework for managing dysphagia. It is a critical, evidence-based fluid consistency used to improve safety and hydration for those with swallowing difficulties by slowing the liquid's flow. By understanding its characteristics and using objective testing methods like the IDDSI Flow Test, caregivers and healthcare professionals can ensure that liquids are prepared and served at the correct and safest consistency for the individual. Any questions regarding the appropriate IDDSI level should be directed to a qualified speech and language therapist or dietitian.
Understanding the International Dysphagia Diet Standardisation Initiative
For those interested in learning more about the comprehensive IDDSI framework, including all eight levels of food and fluid consistency, visit the official website for additional resources and detailed information on testing methods. The International Dysphagia Diet Standardisation Initiative
