Understanding IDDSI Level 1 Thickened Liquids
For individuals with swallowing disorders, or dysphagia, drinking thin liquids like water can pose a serious risk of aspiration, where fluid accidentally enters the lungs. The IDDSI framework provides a global standard for modifying food and drink textures to ensure safer swallowing. Level 1, or 'slightly thick,' is the least thickened liquid consistency, designed to slow the flow of fluids and give a person more time to control the swallow. These fluids are thicker than water but run off a spoon easily and can typically be consumed from a cup, and sometimes with a straw, as recommended by a healthcare professional.
The Importance of Correct Consistency
Getting the consistency right is non-negotiable for safety. Liquids that are too thin still present an aspiration risk, while those that are too thick can be difficult to swallow and lead to reduced fluid intake and potential dehydration. The specific instructions for thickening agents must be followed precisely, as different brands and even different liquids can require slightly different measurements to achieve the correct Level 1 consistency.
How to Make Level 1 Fluids Step-by-Step
Preparing Level 1 fluids correctly is a straightforward process once you understand the steps. Always begin with the specific thickening powder prescribed by a doctor or speech and language therapist (SLT).
- Gather Supplies: You will need your prescribed commercial thickening powder (e.g., Resource ThickenUp Clear, Nutilis Clear), the liquid you wish to thicken, a dry mixing cup, and a utensil for stirring, such as a fork or whisk.
- Measure Accurately: Measure out the correct volume of the base liquid (e.g., 200ml) into your cup.
- Add Powder to Dry Cup: Place the recommended number of level scoops of thickener into the dry cup first. This helps prevent lumps from forming.
- Mix Thoroughly: Pour the liquid over the powder and stir briskly for about 20-30 seconds, or until the powder is fully dissolved. Using a whisk or fork can help achieve a smoother mix.
- Allow to Stand: Let the mixture stand for the recommended time, usually 1 to 5 minutes, to reach its final thickness.
- Test Consistency: Before serving, perform the IDDSI flow test. After 10 seconds, a Level 1 liquid will leave between 1-4 ml in a 10 ml syringe. If too thick, add a little unthickened liquid; if too thin, add a little more powder and repeat the process.
Tips for Different Liquids
- Hot Drinks: Allow hot liquids to cool slightly before adding thickener, as heat can affect consistency. Some thickeners work better in hot liquids than others.
- Fizzy Drinks: Stir the carbonated beverage to remove the fizz before adding the thickener.
- Naturally Thick Liquids: Some liquids like certain fruit nectars, tomato juice, and milk are naturally slightly thicker. These can sometimes be used directly, but always verify with a healthcare professional and perform the IDDSI test to be safe.
- Preparing in Batches: Cold drinks can be prepared in larger quantities and stored covered in the refrigerator. However, thickened liquids should be used within 24 hours when refrigerated, as they can continue to thicken over time.
Naturally Thickened vs. Powder Thickened Liquids
| Aspect | Powder-Thickened Liquids | Naturally Thick Liquids |
|---|---|---|
| Preparation | Requires mixing a commercial powder with a thin liquid, following specific ratios. | Requires no preparation or minor adjustments, as they are already at or near Level 1 consistency. |
| Consistency Control | Highly controlled and predictable if mixing instructions and testing are followed correctly. | Can vary by brand or batch; requires testing to ensure safe Level 1 consistency. |
| Examples | Water with thickener, tea with thickener, juice with thickener. | Some nectars (e.g., apricot, peach), vegetable juices (e.g., tomato), and certain milkshakes. |
| Cost | Involves the recurring cost of commercial thickener powder, often prescribed by a doctor. | Can be cost-effective if purchased and tested correctly; readily available at grocery stores. |
| Professional Guidance | Necessary for dosage and brand recommendation. | Should still be confirmed with a healthcare professional to ensure appropriateness. |
Important Safety and Nutrition Considerations
- Never Add Ice: Adding ice cubes to a thickened fluid will cause the liquid to become thinner as the ice melts, making it unsafe for the individual.
- Straining is Key: When thickening liquids from food, such as soup broth, always strain or sieve the liquid first to remove any lumps or fibers that could be a choking hazard.
- Stay Hydrated: People on thickened fluids may be at risk of dehydration if they find the altered consistency unappealing and reduce their fluid intake. Offering a variety of appealing, thickened drinks and monitoring daily intake is essential.
- Medication and Thickened Fluids: Do not take medication with unthickened liquids if on a thickened fluid diet, unless a healthcare professional has given explicit clearance.
- Use the Right Tools: For safety, a speech and language therapist should advise on the use of straws, as they can sometimes increase the risk of aspiration.
- For more information, consult the International Dysphagia Diet Standardisation Initiative guidelines at https://iddsi.org/framework/.
Conclusion
Making Level 1 fluids is a vital skill for anyone caring for an individual with dysphagia, ensuring both their safety and nutritional needs are met. By following the correct procedure with prescribed commercial thickeners, accurately testing the consistency, and being mindful of important safety considerations, caregivers can confidently prepare drinks that are safer and more manageable. Always remember to work closely with a healthcare team, including an SLT and dietitian, to ensure the best care and to make any necessary adjustments to the diet over time.
