The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a framework with specific levels to ensure the safe intake of foods and liquids for people with dysphagia (swallowing difficulties). Level 2, designated as 'Mildly Thick,' is a common prescription from speech-language pathologists for individuals who have trouble controlling thin liquids due to their fast flow. Understanding the characteristics and common examples is crucial for proper meal preparation and patient safety.
What are the characteristics of a Level 2 mildly thick liquid?
A Level 2 liquid, also known as 'nectar-thick' under older terminology, flows at a slower rate than thin liquids like water. This provides the individual with more time and control during the swallowing process, reducing the risk of aspiration (where fluid enters the lungs). Key characteristics include:
- Pourable: It is easily pourable, but moves more slowly than thin drinks.
- Sippable: It can be sipped from a cup.
- Straw-usable (with effort): It is possible to drink this liquid with a straw, but it requires some effort due to its thicker consistency.
- Leaves a coating: When poured off a spoon, it leaves a thin coating on the spoon.
Common examples of a Level 2 mildly thick liquid
Identifying beverages that naturally fall into this category or knowing how to modify them is essential. While many drinks need thickeners added, some commercial products may already meet this consistency.
Naturally Occurring and Modified Examples:
- Milkshakes and thick shakes: Many commercially prepared milkshakes and thick shakes naturally possess a mildly thick consistency.
- Certain fruit nectars: Some brands of thicker fruit nectars, like apricot or pear nectar, can qualify as Level 2, but should always be tested.
- Creamed soups: Some thicker cream soups, once strained to remove any lumps, can have a consistency similar to a mildly thick liquid.
- Fortified milk: Milk can be thickened with a commercial thickening powder to reach the Level 2 standard, which is often used for fortified drinks for those needing to gain weight.
- Thickened coffee or tea: Hot beverages like coffee and tea can be thickened using a prescribed thickening powder, following specific instructions.
How to prepare a Level 2 mildly thick liquid
When preparing thickened liquids at home, consistency is key to safety. Commercial thickening powders are available and come with specific instructions.
- Measure carefully: Use the provided scoop with the thickening powder to measure the correct amount for your specified liquid volume.
- Add thickener: Add the powder to the liquid and stir vigorously for the time indicated on the packaging.
- Allow to set: Let the mixture stand for the recommended time (typically a few minutes) to reach its final thickness.
- Perform the IDDSI Flow Test: For clinical certainty, use the IDDSI Flow Test with a 10mL syringe. A Level 2 liquid will leave between 4mL and 8mL of liquid in the syringe after 10 seconds of flow.
Comparison of IDDSI Liquid Levels
The IDDSI framework uses a spectrum of classifications to address various swallowing needs. Here is a comparison of common liquid levels:
| Feature | Level 0: Thin | Level 2: Mildly Thick | Level 3: Moderately Thick |
|---|---|---|---|
| Consistency | Water-like | Nectar or syrup-like | Honey or yogurt-like |
| Pourability | Flows like water | Pours quickly, but slower than water | Drips slowly off a spoon in dollops |
| Straw Use | Easy to drink through any straw | Requires some effort to use a standard straw | Very difficult to drink through a straw |
| From a Cup | Easily drinkable | Easily sipped | Drinkable with a cup, but may be easier with a spoon |
| Appearance | Clear residue on a spoon | Leaves a thin coating on a spoon | Coats the spoon and drips slowly |
Important considerations when managing thickened liquids
Patient safety and quality of life are the top priorities when managing a thickened liquid diet. Considerations include hydration, medication efficacy, and palatability.
- Hydration: Individuals on thickened liquids may drink less due to altered taste and texture. Close monitoring of hydration status is necessary.
- Medication: The viscosity of thickened liquids can affect the dissolution and absorption of certain oral medications. Always consult with a pharmacist regarding the administration of medications with thickened liquids.
- Temperature effects: The consistency of thickened liquids can change with temperature. For example, a drink thickened when cold may become thinner when heated. Always test the consistency at the intended serving temperature.
- Avoiding problem foods: Some foods that seem safe can be hazardous. Ice cream, gelatin (Jell-O), and sherbet melt into thin liquids in the mouth, posing a risk. These should be avoided unless specifically cleared by a professional.
Conclusion
A Level 2 mildly thick liquid is a vital tool in managing dysphagia, providing a safer swallowing experience for many individuals. Examples range from naturally occurring thick shakes to specially prepared thickened juices or soups. By following IDDSI guidelines for preparation and testing, and remaining aware of the nuances involved, caregivers and healthcare providers can significantly improve the safety, nutrition, and quality of life for those with swallowing disorders. Always remember that consistency is critical, and the safest approach is to follow professional guidance from a speech-language pathologist.
Additional resources
- IDDSI: Use of Level 2 Mildly Thick Liquids for Adults: This consumer handout from the IDDSI website provides detailed information about Level 2 liquids for adults.
- Memorial Sloan Kettering Cancer Center: About Thickening Liquids: A patient education guide covering the reasons for and methods of thickening liquids.
