Understanding IDDSI Level 2: The Foundation of Thickened Liquids
For individuals with dysphagia, or swallowing difficulties, thickened liquids are a critical part of their nutritional diet. The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a globally recognized framework for describing food and drink textures, ensuring consistency and safety across different care settings. IDDSI Level 2 is defined as a "Mildly Thick" liquid. This consistency is still sippable from a cup but requires more effort than a thin drink and flows quickly from a spoon, but slower than a regular liquid. It is essential for patients and caregivers to achieve this specific consistency to maximize swallowing safety while maintaining adequate hydration. A Speech and Language Therapist (SLT) or other healthcare professional determines the appropriate level of thickness for each patient based on their specific needs.
To ensure the correct viscosity is achieved, IDDSI recommends a simple flow test using a 10 mL syringe. For Level 2 liquids, a volume of 4–8 mL should remain in the syringe after 10 seconds of flow. This quick and simple test can be performed at home to verify the thickness before consumption, adding an extra layer of safety to the dysphagia diet.
Why the Number of Scoops Varies Among Brands
The most significant factor determining the number of scoops needed for Level 2 thickener is the product manufacturer. There is no single, universal answer because:
- Formulation differences: Thickeners are made from different bases. Some are starch-based, while modern, more stable versions often use xanthan gum. These different ingredients interact with liquids differently and therefore require varying amounts to achieve the same level of thickness.
- Scoop size: The scoop provided in the container is proprietary to that specific brand and product line. As such, a scoop from one brand will measure a different amount of powder than a scoop from another.
- Type and temperature of liquid: The liquid being thickened also plays a role. Factors like fat content (in milk) and temperature can alter the final consistency. For example, some thickeners may require fewer scoops for clear liquids like water compared to thicker liquids like oral nutritional supplements. High-fat liquids like milk can be more difficult to thicken and may become lumpy if not mixed correctly.
Brand-Specific Scoop Guidelines for Level 2
Because of the variability, it is crucial to consult the specific instructions on the thickener packaging and use the scoop provided with that product. Below is a comparison table illustrating some common brand-specific guidelines, but these are for informational purposes only. Always refer to your product's specific label.
| Thickener Brand (Example) | Volume of Liquid | Scoops for IDDSI Level 2 | Notes |
|---|---|---|---|
| Resource ThickenUp Clear | 200 mL | 2 level scoops | Add powder to dry cup first, then liquid. |
| Nutilis Clear (Green Scoop) | 200 mL | 2 level scoops | Follow brand instructions; new scoop sizes may differ. |
| Thick & Easy™ Clear | 200 mL | 2 scoops | Wait a specified time for optimal thickness. |
| Unspecified Gum-Based | 200 mL | 2 scoops | Common guideline, but always verify with product. |
| Simply Thick® (Packet) | 5-6 ounces | 1 packet | Different measurement system (packets). |
How to Prepare Level 2 Thickened Liquids Safely
Regardless of the brand, consistent preparation is key to achieving the correct thickness. Following a standardized procedure helps prevent errors and ensures the liquid is safe for the patient.
Step-by-step preparation guide:
- Read Instructions: Always start by reading the manufacturer's instructions on the packaging, as they can vary by brand and product type.
- Measure Accurately: Measure the liquid (e.g., 200 mL) and the correct number of level scoops of powder as specified by the product label. Over- or under-thickening is a significant risk.
- Mix Correctly: For many brands, the best practice is to add the powder to a clean, dry cup or glass first. Then, add the liquid while stirring immediately. Use a fork or whisk to prevent clumping.
- Stir Thoroughly: Stir continuously until the powder is fully dissolved. Some liquids, especially milky ones, may require more vigorous mixing.
- Stand Time: Many thickeners need a specific standing time (e.g., 1 minute) to reach their final consistency. Do not serve until this time has elapsed and the liquid has thickened appropriately.
- Verify Thickness: Before serving, check the liquid's consistency. If it's too thin, wait a few more minutes, as some thickeners continue to work for a short period. If still too thin, you may need to add a small amount of additional thickener, being careful not to over-thicken. The IDDSI Flow Test is the most reliable method for verification.
Potential Risks and Best Practices for a Dysphagia Diet
While thickened liquids are crucial for managing dysphagia, they are not without potential downsides. Awareness and proactive management of these issues are essential for a successful nutritional diet.
- Dehydration Risk: Individuals on thickened liquids often consume less fluid due to altered taste, palatability, and the feeling of satiety. Caregivers must actively monitor and encourage fluid intake. Ensuring good oral hygiene is also important for individuals who are not drinking thin fluids, as pure water can be beneficial for flushing bacteria from the mouth.
- Bioavailability of Medication: Thickened liquids can affect how quickly and effectively the body absorbs certain medications. This is especially true for drugs that are sensitive to viscous substances or have a specific ionic charge. Always consult a pharmacist about the correct and safest way to administer medications when using thickeners.
- Non-Compliance: Some patients dislike the taste and texture of thickened liquids, leading to non-compliance. Gum-based thickeners have been noted to have a more pleasant taste and smoother texture than older starch-based options. Patient preference should be considered whenever possible. Use flavorful sugar-free drinks or alternatives to plain water if a patient is unwilling to drink thickened water.
The Role of the Healthcare Team
Managing a dysphagia diet is a multidisciplinary effort involving the patient, caregivers, an SLT, a Registered Dietitian, and potentially a pharmacist. The SLT's assessment determines the required thickness level, while the dietitian monitors the patient's nutritional and hydration status. Regular reassessment and open communication with the healthcare team are vital to adjust the diet as the patient's condition changes. For more information on the IDDSI framework, you can visit their official website at https://iddsi.org/.
Conclusion
In conclusion, there is no single answer to the question "how many scoops is level 2 thickener?" The correct amount depends on the specific thickener brand and the liquid being thickened. Following manufacturer's instructions precisely, using the provided scoop, and verifying the consistency are essential for safety. While thickened liquids provide a crucial benefit for those with swallowing difficulties, they also carry risks like dehydration and medication interaction that must be actively managed by a vigilant healthcare team and dedicated caregivers. By adhering to brand guidelines and the IDDSI framework, you can help ensure the safety and nutritional well-being of individuals on a modified diet.
