Thickened Liquids - Nutrition Care Manual https://www.nutritioncaremanual.org/topic.cfm?ncm_category_...

Thickened Liquids

Thickeners help to slow the movement of liquids/drinks, allowing patients to have better control over their
swallow. All liquids/drinks should be thickened to meet the prescribed order.

Thickened liquids/drinks may be purchased pre-mixed or may be made by adding commercial thickeners. 
Puree all soups and strain the liquid to remove chunks or lumps. Once these liquids are smooth, thicken
them with flour, cornstarch, potato flakes, or commercial thickeners to the prescribed order.
Beverages such as milk, juices without pulp, coffee, tea, soda, carbonated beverages, alcoholic beverages,
eggnog and nutritional supplements should be thickened to the prescribed order.
Beverages and supplements made with ice cream, frozen yogurt, or sherbet such as malts and milk shakes
are not recommended. These beverages become thin liquids at body temperature (98°F). 
Frozen foods such as sherbet, frozen yogurt, and ice cream are not recommended. These foods become
thin liquids at body temperature (98°F).
Some ice cream and frozen products are designed to meet IDDSI guidelines for liquid/drink levels.
These products are labeled including the level number and color. 
Gelatin is not recommended. It becomes thin liquid at body temperature (98°F).
Yogurt may need to be thickened to the prescribed order.

Utilize IDDSI Thickened Liquid Nutrition Therapy client education handout and individualize with IDDSI Consumer
Handouts or per facility policies and procedures. 

Use the following table to familiarize yourself with the IDDSI guidelines for liquid/drink levels, descriptions, and
testing methods.

IID
DDDSSII LLiiqquuiidd//D
Drriinnkk LLeevveellss  aanndd TTeessttiinngg M
Meetthhooddss

FFoooodd//D
Drriinnkk LLeevveell D
Deessccrriippttiioonn TTeessttiinngg M
Meetthhoodd

Smooth, lump free; not firm or Fork Drip Test: no lumps; stays as
sticky; does not require chewing or mound on fork with very little/no
bolus formation. Falls off spoon as flow through prongs.
Level 4 Extremely thick liquid
intact spoonful and holds shape. No  
(Green)
mixed consistency. Liquids cannot be
  Spoon Tilt Test: Holds shape; not
poured, drank from a cup; or sucked
firm or sticky; sample slides off
through a straw.
easily. If it is too thick, sample will
  not fall off spoon when tilted or will

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Thickened Liquids - Nutrition Care Manual
Level 3 Moderately thick
liquid (Yellow)
Level 2 Mildly thick liquid (Pink)
Level 1 Slightly thick liquid (Grey)
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Smooth foods and fluids without
lumps; does not hold shape on plate;
requires no chewing or oral
processing and can be directly
swallowed. Drips slowly through
slots of fork. Requires moderate
effort to suck through straw.
 
Flows off spoon; pours slower than
thin drinks; Sippable; some effort
needed for straw use; May be
suitable if tongue control slightly
reduced
Thicker than water and flows
through straw, syringe or nipple;
similar to infant formula.  Little more
effort required to drink than thin
stick to spoon.
Fork Test: When fork is pressed into
the food sample, tines make pattern
and/or indentation stays.
IDDSI Flow test not applicable to this
level.
IDDSI Flow Test: See instructions in
IDDSI Framework Testing Methods
 
 
Fork Drip Test: Drips slowly in
dollops; spreads out if spilled onto
flat surface (plate).
Fork Test: When fork is pressed into
the food sample, the tines do not
leave a clear pattern.
Spoon Tilt Test: Easily pours; no
sticking to spoon.
IDDSI Flow Test: See instructions in
IDDSI Framework Testing Methods
 
IDDSI Flow Test: See instructions in
IDDSI Framework Testing Methods
 
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Thickened Liquids - Nutrition Care Manual https://www.nutritioncaremanual.org/topic.cfm?ncm_category_...

liquids.

Flows like water; can drink through

any teat/nipple, cut or straw per IDDSI Flow Test: See instructions in
Level 0 Thin liquids (White) age/skill IDDSI Framework Testing Methods

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