Extremely thick drink IDDSI Level 4

IDDSI is the International Dysphagia Diet Standardisation Initiative.

Why is this drink thickeness needed?

Thickened drinks may be used if you have difficulties swallowing thin drinks, for example water or any other drink that flows like water.

Thin drinks travel quickly through the mouth and throat. This can sometimes result in them ‘going the wrong way’. This is known as aspiration.

Thickening your drink can sometimes reduce the risk of aspiration by keeping the liquid together and slowing the movement of the drink in the mouth and throat to allow the swallowing muscles to ‘catch up’.

Not everyone needs their fluids thickened to the same consistency. How thick the drink needs to be depends on the person’s swallowing difficulty.

Thickened fluids should only be recommended after a swallowing assessment by a speech and language therapist (SLT). Your doctor can prescribe the thickener for you.

What is an extremely thick drink?

• A drink that can be eaten with a spoon.
• It sits in a mound or pile above the fork.
• It holds its shape on a spoon and falls off in a single spoonful when tilted.
• It has a smooth texture with no lumps.
• Cannot be drunk from a cup or drunk through a straw.
• Must not be sticky.

Extremely thick drink IDDSI Level 4 preparation

Tips

• You need to use a thickening powder to thicken your drink.
• The thickener used in Addenbrooke’s Hospital is Resource ThickenUp Clear.

STOP: Please note that if you are using a different brand of thickener, the mixing instructions may differ – please check the packaging for instructions and/or discuss with your SLT.

It is important that all your drinks are Extremely Thick.

• If you are taking nutritional supplements the Dietician or Speech and Language Therapist will be able to advise you on which nutritional supplements are available for your recommended drink consistency. Thickening nutritional supplements are not recommended.
• If you are taking any liquid medication, please discuss with your pharmacist if these can be thickened to the appropriate consistency or whether there are any suitable alternative options.

Method

Allow to stand for one minute before serving.

References/ Sources of evidence

© The International Dysphagia Diet Standardisation Initiative 2019 (opens in a new tab) @ Licensed under the CreativeCommons Attribution Sharealike 4.0 License.

Nestle (2023) Resource® ThickenUp® Clear (Accessed: 27 February 2023).