Understanding the Confusion Between Mild and Moderate
The naming of thickened liquids has historically caused confusion, with different systems and terminologies used over the years. This is especially true when trying to determine if nectar thick liquids are mild or moderate. The International Dysphagia Diet Standardisation Initiative (IDDSI) was created to unify these standards globally, replacing older classification systems like the National Dysphagia Diet (NDD). Under the new, globally recognized IDDSI framework, nectar thick is explicitly defined as Level 2: Mildly Thick.
The previous NDD system referred to nectar thick liquids as Level 2, while honey thick was Level 3. The IDDSI, however, uses different names and more precise measurement methods, leading to clearer classifications. For instance, IDDSI Level 3 is defined as Moderately Thick, which corresponds to the consistency of honey, not nectar. This distinction is critical for patient safety, as assigning the wrong thickness level can have serious health consequences, such as aspiration pneumonia.
The Importance of Correct Consistency for Dysphagia
Individuals with dysphagia, or difficulty swallowing, require thickened liquids to ensure safe hydration. Thin liquids, like water, move too quickly and can enter the windpipe instead of the esophagus, a phenomenon called aspiration. By thickening liquids, their flow rate is slowed, giving the individual more time to control the swallow and protect their airway.
A speech-language pathologist (SLP) is typically the healthcare professional who assesses swallowing function and prescribes the appropriate liquid consistency. They will specify the precise level of thickness required for a patient's safety. Following these guidelines meticulously is paramount, as an incorrect consistency can increase the risk of aspiration or, if too thick, lead to dehydration due to a reluctance to consume.
Making Nectar Thick Liquids
Creating mildly thick (nectar thick) liquids involves adding a commercial thickener, such as a starch-based powder or a gel-based product, to a standard liquid.
- Read the Label: Always follow the manufacturer's instructions for the specific thickener you are using, as ratios can vary.
- Proper Mixing: Stir the thickener thoroughly into the liquid to prevent lumps. A shaker cup or blender can help achieve a smooth consistency.
- Allow to Stand: Many thickeners require a few minutes to reach their final viscosity. Patience is key to achieving the correct thickness.
- Beware of Temperature: The temperature of the liquid can affect the final thickness. For example, some drinks may thicken further as they cool.
Comparison Table: Mildly Thick vs. Moderately Thick
| Feature | Mildly Thick (IDDSI Level 2, Nectar) | Moderately Thick (IDDSI Level 3, Honey) |
|---|---|---|
| Consistency | Easily pourable, similar to apricot nectar or a thick cream soup. | Pours more slowly, like honey or a thick shake. |
| Flow Rate | Pours quickly off a spoon but slower than water. | Drips slowly in dollops from a spoon or fork. |
| Straw Use | Possible with some effort for a standard straw. | May require a wide-bore straw, if advised, but is challenging. |
| IDDSI Flow Test | 4–8 ml remaining in a 10ml syringe after 10 seconds. | Over 8 ml remaining in a 10ml syringe after 10 seconds. |
| Function | Provides more controlled swallowing than thin liquids. | Slower flow for more significant swallowing difficulties. |
The IDDSI Framework: A Unified Standard
The IDDSI framework provides clear, descriptive terminology and simple tests to ensure consistency levels are accurate across all settings. The framework consists of a continuum of eight levels, numbered 0–7, encompassing both food and drink. The simple IDDSI flow test, using a 10ml syringe, removes the subjective interpretation of terms like "nectar-like," providing a measurable, objective standard. This standardization is a massive improvement over older, often vague, diet guidelines and helps protect individuals with dysphagia.
Clinical and Home Application
For caregivers and patients at home, understanding the correct consistency is critical. An SLP will provide specific instructions, often recommending a commercial thickener and dosage for a particular liquid. Adhering to these instructions is the best way to prevent complications. For example, adding too little thickener means the liquid is still unsafe, while adding too much can lead to an unappetizingly thick beverage that reduces fluid intake, potentially leading to dehydration.
Furthermore, certain foods that are thin at room temperature but thicken when cold (e.g., milkshakes, ice cream, gelatin) must also be treated with caution, as they can revert to a thin consistency in the mouth, posing a risk. Consulting with a healthcare professional or a registered dietitian specialized in dysphagia can provide additional strategies for maintaining hydration and nutritional intake while on a modified diet. Consult the IDDSI website for testing methods and additional resources.
Conclusion: The Final Word on Nectar vs. Moderate
To definitively answer, nectar thick liquids are classified as mildly thick (IDDSI Level 2), not moderately thick. The moderately thick classification (IDDSI Level 3) refers to a much thicker, honey-like consistency. The adoption of the IDDSI framework has provided a universal standard, eliminating the historical ambiguity and ensuring better safety for individuals with swallowing difficulties. Always consult a healthcare professional for a swallowing evaluation and specific dietary recommendations to ensure the correct liquid consistency is used for effective and safe dysphagia management.
