What is the International Dysphagia Diet Standardisation Initiative (IDDSI)?
The International Dysphagia Diet Standardisation Initiative, or IDDSI, is a global framework for describing the texture of food and the thickness of liquids. The framework provides a standardized system using eight levels, from 0 (Thin) to 7 (Regular), with specific descriptors and simple testing methods for each. This standardization is critical for patient safety, as it ensures that healthcare providers, caregivers, and patients around the world are all referring to the same consistency, regardless of brand or location.
Level 2 is specifically designated for "Mildly Thick" liquids. This consistency is thicker than water but pours quickly from a spoon, albeit more slowly than thin or slightly thick drinks. It is sippable from a cup and can be consumed through a standard bore straw with some effort. The official IDDSI Flow Test provides a definitive way to check the consistency. Using a 10 mL syringe, a Level 2 mildly thick liquid will have 4 to 8 mL remaining after 10 seconds of flow.
Who Benefits from a Level 2 Mildly Thick Drink?
Individuals with a swallowing disorder known as dysphagia are the primary beneficiaries of thickened liquids. Dysphagia can be caused by various medical conditions, including neurological disorders, stroke, or as a side effect of aging or certain treatments. In these cases, thin liquids (like water or juice) can move too quickly for the individual to control, potentially entering the airway and lungs rather than the stomach. This is called aspiration and can lead to serious complications like pneumonia. By slowing the flow rate, a Level 2 mildly thick drink provides the individual's swallowing muscles more time to coordinate, making drinking safer.
A Speech and Language Therapist (SLT) or speech pathologist will assess an individual's swallowing ability and prescribe the appropriate liquid thickness. It is crucial to follow their recommendation, as the correct level is determined by the specific nature of the dysphagia.
Common conditions where a Level 2 mildly thick drink might be recommended include:
- Post-stroke recovery
- Parkinson's disease
- Dementia
- Head and neck cancers
- Cerebral palsy
- Age-related swallowing difficulties
Preparing a Level 2 Mildly Thick Drink
Most Level 2 mildly thick drinks are prepared by adding a thickening powder or gel to a thin liquid, though some products may be pre-thickened. The amount of thickener required will vary depending on the brand and the type of liquid. Always follow the manufacturer's instructions and the specific advice of a healthcare professional.
General Preparation Steps
- Start with the Correct Proportions: Measure the specified amount of thickening powder, often into a clean, dry cup. For example, some brands recommend two level scoops for every 200 ml of liquid.
- Add the Liquid: Pour the thin liquid (e.g., water, juice, or milk) into the cup with the powder.
- Mix Thoroughly: Stir the mixture well with a fork or whisk until the powder is fully dissolved and there are no lumps. Some products may suggest using a shaker for better results.
- Allow to Stand: Let the drink sit for the recommended time, often around 1 to 5 minutes, to reach the final consistency. Some liquids, especially milky drinks, may take longer.
- Check the Consistency: Before serving, perform a simple check. The liquid should pour from a spoon quickly but leave a thin, visible coating. If unsure, use the IDDSI Flow Test with a 10 ml syringe.
Important Considerations
- Hot vs. Cold Drinks: Some thickeners perform differently with temperature. For hot beverages, stir rather than shake, and for milky drinks, ensure thorough mixing.
- Carbonated Drinks: Fizz must be stirred out before adding the thickener.
- Flavoring: Thickeners are typically neutral-flavored. Adding flavoring like cordial before thickening can improve the taste.
Common Misconceptions and Safety Precautions
There are several important safety points to remember when dealing with thickened fluids:
- Melting Foods: Avoid foods that become thin liquids at room temperature, such as ice cream, jelly, or sherbet, as they will revert to a consistency that is unsafe for the individual.
- Using Straws: While a Level 2 liquid can be drunk through a standard straw, the use of straws or spouted cups may not be safe for all individuals with dysphagia. It can increase the risk of aspiration by directing the liquid too far back into the mouth. Always follow the advice of the SLT regarding the use of straws.
- Storing Thickener: Dry thickening powder can be dangerous if accidentally ingested or inhaled. It should always be stored in a safe and secure place, out of reach of children and vulnerable adults.
- Medication: Never assume liquid medications can be thickened along with drinks. Always consult a doctor or pharmacist for specific advice on how to manage medication while on a thickened liquid diet.
- Don't Rush: Swallowing takes more time with thickened liquids. Encourage the individual to sit upright, take small sips, and avoid distractions.
The IDDSI Framework: A Comparison of Liquid Levels
To better understand the spectrum of liquid consistencies, here is a comparison of the different IDDSI liquid levels.
| IDDSI Level | Name | Consistency Description | IDDSI Flow Test (10 mL syringe) |
|---|---|---|---|
| 0 | Thin | Flows like water; fast flow rate. | <1 mL remaining after 10 seconds |
| 1 | Slightly Thick | Thicker than water, but flows easily; similar to baby formula. | 1–4 mL remaining after 10 seconds |
| 2 | Mildly Thick | Slower flow than Level 1; pourable, like nectar or a thin milkshake. | 4–8 mL remaining after 10 seconds |
| 3 | Moderately Thick | Drips slowly off a spoon; similar to honey or thick yogurt; requires a wide straw. | >8 mL remaining after 10 seconds |
| 4 | Extremely Thick | Holds shape, not pourable; similar to pudding; must be eaten with a spoon. | No drip/flow from syringe |
For more detailed information on the IDDSI framework and testing methods, you can visit the official IDDSI Framework.
Conclusion
A Level 2 mildly thick drink is an essential tool for managing dysphagia and ensuring the safety and hydration of those with swallowing disorders. By adhering to the standardized IDDSI framework, caregivers and healthcare providers can ensure consistent and safe preparation. Understanding the correct consistency, knowing the proper preparation techniques, and being aware of safety precautions are all vital for successful management. This approach not only prevents potentially dangerous complications like aspiration but also helps individuals maintain adequate fluid intake and quality of life.
