What is IDDSI Level 2 Mildly Thick?
IDDSI Level 2 is a standardized consistency for liquids, also known as 'mildly thick' or 'nectar thick'. This level is used for individuals with dysphagia (swallowing difficulties) who cannot safely consume thin fluids like water. The slower flow rate of mildly thick fluids gives the person more time to control the liquid in their mouth and throat, reducing the risk of aspiration (inhaling food or liquid into the lungs). Mildly thick drinks are sippable from a cup and can be drunk through a straw, though it requires slightly more effort than thin liquids. This consistency should not be confused with Level 3 (moderately thick) or Level 1 (slightly thick).
How to achieve Level 2 with Pump Thickeners
Achieving a mildly thick (Level 2) consistency with a pump dispenser is straightforward when following manufacturer guidelines. For the popular brand SimplyThick EasyMix, the general recommendation involves a specific ratio of pumps per volume of liquid.
To prepare a drink, it is important to follow the specific instructions on the product packaging:
- Measure the desired volume of your chosen beverage (water, juice, coffee) into a glass.
- Dispense the recommended number of pumps of SimplyThick EasyMix based on the liquid volume, according to the manufacturer's instructions.
- Stir the mixture briskly for the time recommended by the manufacturer, typically around 30 seconds, until the thickener is fully dissolved and the liquid is a uniform consistency.
- After mixing, it is highly recommended to perform the IDDSI Flow Test to confirm the correct thickness before serving.
It is vital to follow these brand-specific instructions precisely. Using more or less thickener than recommended can result in a consistency that is either unsafe or ineffective for the individual's swallowing needs. Different versions or sizes of a product might have varying instructions, so always refer to the specific bottle or packaging for the most accurate guidance.
Comparing Pump vs. Powder Thickeners
While pumps offer a quick and convenient method for single-serving beverages, powdered thickeners are also widely used and have different preparation instructions. A comparison helps illustrate why following specific product directions is so important.
| Feature | Pump Thickener (e.g., SimplyThick EasyMix) | Powdered Thickener (e.g., Resource ThickenUp Clear) |
|---|---|---|
| Convenience | Fast and easy for single servings. Ready quickly, often in about 30 seconds. | Can be messy and may require more thorough stirring. Often requires a standing time (e.g., 1-5 minutes). |
| Preparation | Dispense a specific number of pumps into liquid and stir, as per instructions. | Measure powder with a provided scoop, add to liquid, and stir until dissolved. |
| Ratio (for L2) | Varies by brand and liquid volume. | Varies by brand and liquid volume. |
| Texture | Generally produces a smooth, lump-free consistency. | Can be prone to clumping if not mixed quickly and correctly. |
| Usage | Best for individual drinks, though bulk options are available. | Versatile for both single servings and larger batches. |
How to verify consistency with the IDDSI Flow Test
The most reliable way to ensure a liquid is the correct IDDSI Level 2 consistency is the IDDSI Flow Test. This method provides an objective measure of thickness. The test requires a 10ml syringe, which is standard for the IDDSI protocol.
- Prepare a 10ml syringe: Ensure the syringe has a visible 10ml line and is clean.
- Draw up the liquid: Fill the syringe with the prepared thickened liquid up to the 10ml mark.
- Place finger over nozzle: Cover the nozzle at the bottom of the syringe with your finger.
- Release and count: Release your finger and start a timer for 10 seconds.
- Observe the flow: After 10 seconds, immediately cover the nozzle again to stop the flow.
- Read the result: Look at the syringe and read the amount of liquid remaining. For a valid Level 2 mildly thick fluid, the liquid remaining should be between 4ml and 8ml.
- Adjust if needed: If the remaining liquid is outside this range, you may need to adjust the ratio of thickener to liquid and re-test. Never add more thickener directly to a lumpy beverage; start with a new batch.
The importance of professional guidance
Thickening fluids is a medical intervention for individuals with dysphagia and should always be done under the supervision of a healthcare professional, such as a Speech-Language Pathologist or a registered dietitian. They will assess the individual's swallowing ability and recommend the specific thickness level required for safety. It is important not to self-diagnose or make changes to a thickened liquid diet without professional advice. The wrong consistency can still pose a risk of aspiration. For more information on the IDDSI framework and testing methods, the official IDDSI website is an authoritative source.
Conclusion
Determining the number of pumps for level 2 thickened fluids depends entirely on the specific thickener product used and its instructions. Regardless of the brand or type of thickener (pump or powder), confirming the final consistency with the IDDSI Flow Test is the safest practice. Always adhere to manufacturer instructions and, most importantly, follow the guidance of a qualified healthcare professional to ensure the individual with dysphagia receives the correct and safest diet. Consistent and accurate preparation is key to reducing the risk of complications from swallowing difficulties.
Visit the official IDDSI website for the complete framework and testing methods.
