From Traditional Terminology to a Global Standard
For decades, medical professionals used descriptive terms like "nectar thick," "honey thick," and "pudding thick" to describe the consistency of thickened liquids for patients with swallowing disorders, or dysphagia. While these terms were common in some regions, they lacked the precision needed for a global healthcare system. For example, what one person considers "nectar thick" might be different from another's interpretation, creating potential safety risks. In 2015, the International Dysphagia Diet Standardisation Initiative (IDDSI) was created to resolve these inconsistencies with a universal, numbered framework. This framework has been widely adopted by healthcare organizations and facilities to improve patient safety.
The Shift to Mildly Thick Liquids
Under the new IDDSI framework, the old designation of nectar thick is now known as Level 2 - Mildly Thick. This new nomenclature, along with the entire IDDSI framework, provides clear, objective measurements for liquid consistency, which helps to minimize confusion and reduce the risk of choking or aspiration pneumonia for individuals with dysphagia. Instead of relying on subjective comparisons, IDDSI uses a simple, reliable syringe flow test to verify the exact thickness of a liquid. For a liquid to qualify as Mildly Thick, the flow test dictates that between 4 and 8 mL of a 10 mL sample must remain in the syringe after 10 seconds.
Why the Change Was Necessary
The move away from terms like "nectar thick" was driven by a need for consistency and safety. The reasons behind the shift include:
- Global Clarity: Terminology like "nectar" was not universally understood in all countries or cultures. IDDSI's numbered levels and descriptive terms provide a common language for all clinicians and caregivers.
- Eliminating Ambiguity: The viscosity of common foods and drinks like nectars can vary significantly between brands and even production batches. The IDDSI flow test provides a concrete, repeatable method for confirming thickness.
- Preventing Misinterpretation: In a high-stakes clinical setting, a misunderstanding of liquid consistency could have severe consequences. The IDDSI framework reduces this risk by replacing imprecise descriptions with standardized, testable levels.
Characteristics of IDDSI Level 2 - Mildly Thick Liquids
To understand what Mildly Thick liquids are, it helps to know their specific characteristics:
- Sippable: The liquid is thin enough to be sipped from a cup.
- Pours Quickly: It pours quickly from a spoon, but noticeably slower than water.
- Requires Effort to Drink with a Straw: It takes some muscle effort to drink it through a standard bore straw.
The IDDSI Framework: More Than Just Liquids
The IDDSI framework is a comprehensive system that standardizes both food textures and drink thicknesses. It ranges from Level 0 (Thin) to Level 7 (Regular), with drink levels occupying the lower half of the continuum. Understanding the entire framework provides context for where Mildly Thick liquids fit in.
Here is a comparison of the old dysphagia diet terms and their IDDSI equivalents:
| Old Term (National Dysphagia Diet) | New Term (IDDSI) | IDDSI Level | Flow Test Result (10mL syringe in 10s) | Example Characteristics |
|---|---|---|---|---|
| Thin | Thin | 0 | <1 mL remaining | Flows like water. |
| Not Applicable | Slightly Thick | 1 | 1-4 mL remaining | Thicker than water; flows through a straw. |
| Nectar Thick | Mildly Thick | 2 | 4-8 mL remaining | Requires effort to drink through a straw. |
| Honey Thick | Moderately Thick | 3 | >8 mL remaining | Pours very slowly; often taken with a spoon. |
| Pudding Thick | Extremely Thick / Pureed | 4 | 10 mL remaining | Holds its shape; must be eaten with a spoon. |
Conclusion
The transition from outdated terms like "nectar thick" to the precise, internationally recognized standard of Level 2 - Mildly Thick is a significant step forward in dysphagia management. By providing a common terminology and reliable testing methods, the International Dysphagia Diet Standardisation Initiative (IDDSI) helps to reduce confusion and improve the safety of individuals with swallowing difficulties. While adjusting to new terminology can take time, the enhanced safety and clarity it provides are invaluable for both healthcare providers and the patients they serve.
For more detailed information on testing methods and the full framework, visit the official IDDSI website. International Dysphagia Diet Standardisation Initiative
