Understanding the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative (IDDSI) created a global, standardized framework of terminology for dysphagia diets to improve patient safety. Previously, terms like 'nectar thick' or 'honey thick' were interpreted inconsistently, leading to confusion and potential choking hazards. The IDDSI framework uses numbered levels, with Level 2 specifically designating 'Mildly Thick' liquids.
Characteristics of IDDSI Level 2 (Mildly Thick)
Level 2, or mildly thick liquids, have specific characteristics that set them apart from other consistencies. These properties ensure that the liquid flows more slowly than thin fluids, allowing individuals with compromised swallowing functions more time to control the liquid in their mouth and throat.
- Can be sipped from a cup.
- Requires some effort to drink through a standard straw.
- Flows off a spoon quickly but slower than thin liquids like water.
- Leaves a visible, thin coating on the prongs of a fork when tested.
How to Test for Mildly Thick (IDDSI Level 2)
Ensuring the correct consistency is critical for safety. The most reliable method is the IDDSI Flow Test, which uses a standard 10 mL syringe.
IDDSI Flow Test Steps:
- Remove the plunger from a 10 mL syringe.
- Cover the nozzle of the syringe with your finger.
- Pour 10 mL of the liquid into the syringe.
- Release your finger and allow the liquid to flow out for exactly 10 seconds.
- After 10 seconds, place your finger back over the nozzle and measure the remaining liquid.
- For a mildly thick liquid (Level 2), 4-8 mL should remain in the syringe.
Fork Drip Test:
Alternatively, a less precise but useful visual test involves a fork. When a mildly thick liquid is drizzled from a spoon onto the prongs of a fork, it flows fairly quickly through the prongs but leaves a visible coating behind. This contrasts with slightly thick (Level 1), which leaves only a thin coating, and moderately thick (Level 3), which drips much more slowly and cannot be eaten with a fork.
Benefits of Mildly Thick Liquids for Dysphagia Management
Individuals with dysphagia are at an increased risk of aspiration, where food or liquid enters the lungs. Mildly thick (Level 2) fluids are often prescribed by a Speech-Language Pathologist (SLP) to help mitigate this risk.
Key benefits include:
- Increased Control: The slower flow rate gives the patient more time to prepare for and execute a swallow.
- Reduced Aspiration Risk: By delaying the fluid's passage, the risk of it entering the airway is significantly reduced.
- Improved Hydration: Allows patients to maintain adequate fluid intake safely, which can be challenging with thin liquids.
- Enhanced Nutrition: Patients can receive proper hydration and nutrition from thickened beverages and liquid-based nutritional supplements.
Comparison Table: IDDSI Liquid Consistencies
| IDDSI Level | Terminology | Characteristics | Syringe Flow Test (mL remaining) |
|---|---|---|---|
| Level 0 | Thin | Flows like water. | < 1 mL |
| Level 1 | Slightly Thick | Flows a little slower than water. | 1-4 mL |
| Level 2 | Mildly Thick | Slower flowing, sippable, leaves residue on fork. | 4-8 mL |
| Level 3 | Moderately Thick | Flows more slowly, like honey, requires effort with a straw. | > 8 mL |
| Level 4 | Extremely Thick | Holds shape, eaten with a spoon, not pourable. | > 8 mL (not testable) |
Creating Mildly Thick (Level 2) Fluids at Home
For many patients, fluids can be thickened at home using a prescribed thickening powder or gel. Instructions on the specific product must be followed carefully to achieve the correct consistency.
General steps:
- Ensure you have the correct thickener prescribed by a healthcare professional.
- Measure the recommended number of scoops per volume of liquid.
- Add the thickener to a clean, dry cup or glass.
- Pour the liquid over the powder and stir immediately until completely dissolved.
- Allow the mixture to stand for about a minute before serving, as the consistency will develop.
- Perform the IDDSI flow test to confirm the correct thickness.
Important Considerations
- Safety First: Only consume fluids at the consistency recommended by a Speech-Language Pathologist or other healthcare provider.
- Hydration Monitoring: Adequate hydration is crucial. Patients on thickened fluids may drink less due to the altered consistency. Monitor intake and report concerns.
- Medication: Never thicken medication without first consulting a pharmacist or clinician, as it can affect absorption.
- Variety of Foods: Ensure the entire diet, including sauces and gravies, adheres to the recommended thickness level. For example, thin salad dressings or soups should be avoided unless thickened appropriately.
Conclusion
Yes, mildly thick is indeed IDDSI Level 2, representing a crucial consistency for individuals with dysphagia to drink safely. Defined by its sippable, slower-flowing nature, this consistency is a cornerstone of safe swallowing management. Consistent application and accurate testing, such as with the IDDSI Flow Test, are essential for ensuring patient safety and promoting proper hydration and nutrition. Always consult a healthcare professional for specific recommendations and guidance on managing swallowing difficulties.
For further information on the IDDSI framework and its specific levels, visit the official International Dysphagia Diet Standardisation Initiative website: IDDSI.org.
