What Level Is Honey Thick Liquid According to IDDSI Guidelines?

January 10, 2026 •

3 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), honey thick liquid corresponds to Level 3, known as Moderately Thick. This specific classification is crucial for healthcare professionals and individuals managing dysphagia, a condition that makes swallowing difficult. Proper liquid thickness helps prevent aspiration, where food or drink enters the airway instead of the esophagus.

Quick Summary

Honey thick liquid is designated as Level 3 (Moderately Thick) by the IDDSI framework. This consistency is pourable but flows slowly, similar to liquid honey, and is used for individuals with swallowing disorders. It can be consumed from a cup, but a straw is typically not effective. Healthcare professionals determine this thickness to ensure safe consumption and reduce aspiration risk.

Key Points

Official IDDSI Level: Honey thick liquid corresponds to IDDSI Level 3, also known as Moderately Thick.
Defining Consistency: It is characterized by its slow, pouring movement and tendency to drip from a spoon in dollops, like actual honey.
Swallowing Safety: This thickness is prescribed for individuals with dysphagia to reduce the risk of aspiration by slowing down the liquid's flow.
Testing Methods: Consistency can be verified using the IDDSI Flow Test with a 10 mL syringe or the Fork Drip Test.
Home Preparation: Achieving honey thick consistency involves using commercial thickening agents, following the product's specific instructions, and stirring thoroughly.
Professional Guidance: A speech-language pathologist or dietitian determines the appropriate liquid level, which should be adhered to strictly.

Understanding the IDDSI Framework

The International Dysphagia Diet Standardisation Initiative (IDDSI) was developed to create a universal, standardized language for describing modified foods and thickened liquids. Before IDDSI, inconsistent terminology like "nectar-like" and "honey-like" varied greatly, leading to confusion and potential safety risks for patients with dysphagia. The IDDSI framework uses a numerical scale from 0 (Thin) to 7 (Regular) to define specific texture and liquid levels.

What Defines Moderately Thick (Level 3)?

IDDSI Level 3, or Moderately Thick, is the classification for what is commonly referred to as honey thick liquid. This consistency is defined by its ability to pour slowly, similar to the movement of honey, and to drip off a spoon in dollops rather than a steady stream. While it can often be drunk from a cup, it is very difficult to drink through a straw due to its thickness. This specific level of thickness provides a balance between being thin enough to drink and thick enough to be more manageable for those with swallowing difficulties.

How to Verify Honey Thick Consistency

IDDSI provides simple, easy-to-use testing methods to ensure a liquid is the correct thickness. The IDDSI Flow Test, using a standard 10 mL syringe, is the primary method. After a 10-second flow, a Level 3 (Moderately Thick) liquid will have no less than 8 mL of fluid remaining in the syringe. Another method is the Fork Drip Test, where the liquid should slowly drip in dollops or strands through the tines of a fork. This visual and practical confirmation is vital for caregivers and patients to ensure safety.

Comparison of Thickened Liquid Levels


IDDSI Level	Old NDD Term	Consistency Description	How to Consume
Level 0	Thin	Flows like water; no lumps.	Sips from a cup, drinks through a straw.
Level 1	Slightly Thick	Thicker than water but flows easily.	Sips from a cup, easier than Level 2.
Level 2	Nectar Thick	Flows slowly from a spoon, like nectar or buttermilk.	Sips from a cup, but with some effort.
Level 3	Honey Thick	Drips slowly in dollops from a spoon, like honey.	Sips from a cup; difficult with a straw.
Level 4	Pudding Thick	Holds its shape on a spoon; not pourable.	Eaten with a spoon; not possible with a straw.

Why Thickness Matters for Dysphagia Management

For individuals with dysphagia, the consistency of food and drink is directly related to their swallowing safety. A liquid that is too thin may travel too quickly, entering the airway (aspiration), which can lead to serious respiratory issues like pneumonia. Conversely, a liquid that is too thick may be difficult to swallow and leave residue in the throat, also posing a choking risk.

Speech-language pathologists (SLPs) work with patients to determine the appropriate thickened liquid level based on their specific swallowing abilities. The goal is always to use the least restrictive consistency that is still safe for the patient. A liquid at the honey thick level offers a more controlled flow, allowing the individual more time to manage the liquid in their mouth and trigger a safe swallow reflex.

Preparing Honey Thick Liquids at Home

Creating a consistent honey thick liquid at home is important for compliance and safety. Commercial thickening powders and pre-thickened drinks are available for this purpose. Following the manufacturer's instructions precisely is critical, as the amount of thickener required can vary depending on the liquid and its temperature. Stirring the powder into the liquid immediately and thoroughly is essential to prevent clumps and achieve a uniform consistency. Some common liquids that may be thickened include water, juice, milk, and coffee.

Conclusion

Honey thick liquid is formally recognized as IDDSI Level 3, or Moderately Thick, providing a specific standard for managing dysphagia. This consistency is deliberately less mobile than thinner liquids, helping to increase swallowing safety for those who need it. By using the IDDSI framework and its simple testing methods, caregivers can consistently prepare liquids to the exact specifications prescribed by a healthcare professional. Understanding and adhering to these guidelines are essential steps in protecting patient health and enhancing their quality of life. For more information and resources on preparing thickened liquids, visit the official IDDSI website. [https://www.iddsi.org/].

Frequently Asked Questions

The main purpose of thickening liquids to a honey thick consistency is to make them safer for individuals with dysphagia, or swallowing difficulties. The increased viscosity allows for more control and time during the swallowing process, reducing the risk of aspiration.

No, honey thick liquids are typically too thick and slow-flowing to be effectively or safely consumed through a straw. They are best sipped from a cup or, for some, consumed with a spoon.

You can perform the IDDSI Flow Test at home using a standard 10 mL syringe. After letting the liquid flow for 10 seconds, at least 8 mL should remain in the syringe. A simpler method is the Fork Drip Test, where the liquid should drip slowly in dollops through the tines of a fork.

Nectar thick (IDDSI Level 2) is less viscous and flows more freely than honey thick (IDDSI Level 3). Nectar thick liquids can be sipped from a cup with some effort, whereas honey thick liquids pour much more slowly and are difficult to drink with a straw.

While cornstarch is a thickening agent, it is generally not recommended for therapeutic use due to inconsistent results and potential for change in viscosity over time. Commercial thickeners specifically designed for dysphagia are preferred to ensure a precise and stable consistency.

An incorrectly thickened liquid can pose risks to a person with dysphagia. If too thin, it may increase the risk of aspiration. If too thick, it could increase the risk of choking and lead to dehydration, as it may be unpleasant or difficult to consume.

Yes, unless otherwise specified by a healthcare professional, all liquids should be thickened to the prescribed consistency. This includes water, coffee, juice, and any food items like ice cream or gelatin that melt to a thin liquid at body temperature.