Fact sheetDiet specifications

Published on 1 Nov 2011

Fluid diet - extremely thick

This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.


To provide thickened fluids of extremely thick consistency for patients with dysphagia for whom thinner fluids are unsafe, and to maintain fluid balance using thickened fluids.


Level 900 – extremely thick is similar to the thickness of a pudding or mousse. It is cohesive and holds its shape in a spoon. It is not possible to pour this type of fluid from a cup into the mouth or to drink this thickness through a straw. A spoon is the optimal method for taking this type of fluid.

Testing scales for viscosity exist, but are not formalised or standardised. Subjectively, fluids at this thickness sit on and do not flow through the prongs of a fork.


Swallowing disorders identified by a speech pathologist, such as those associated with stroke, degenerative diseases (including multiple sclerosis, Parkinson’s disease and Guillain-Barré syndrome), and changes to the tongue, palate or pharynx that affect swallowing.

Nutritional adequacy

Care must be taken to ensure adequate fluid intake when thickened fluids replace unmodified fluids. Small quantities should be offered every one or two hours.


No water jug to be left at bedside. Ensure all liquids available to the patient are thickened to the level determined by the speech pathologist. Patients with uncoordinated oral muscles have difficulty controlling the flow of liquid, which can easily enter the airway and lungs, leading to infection. If used alone, this diet may be associated with dehydration and patient hydration needs careful monitoring.


Suitable for use in paediatrics when combined with an age-appropriate diet.

Specific menu planning guidelines

Allowed Not allowed
Hot main dishes All, but sauces need to be thickened to level 900 consistency -
Sauces, gravies All, if small amount served on food Served in a separate jug
Starchy vegetables / pasta / rice All -
Vegetables All -
SoupsPureed and thickened to characteristic level 900 thickness (all band 1)All others
Sandwiches All -
Salads, dressings None -
Breads, cereals

All breads

All cereals, served with level 900 thickened milk

Milk with dry cereal
Spreads All -
Hot breakfast choices

Pureed baked beans

All others

Canned baked beans or spaghetti

Drained canned fruit,

Fresh fruit that produces minimal juice when eaten (e.g. banana, apple).

Dried fruit

Juice from canned fruit

Fresh fruit where juice is produced when eaten (e.g. orange, watermelon, passionfruit)

YoghurtFrûche® onlyYoghurt

Most, including thick custard

Creamy rice is OK

Ice-cream, jelly, crème caramel (unless approved by speech pathologist)
Milk and cheese

Milk must be thickened to level 900 thickness

Milk with dry cereal
BeveragesMust be thickened to level 900 thicknessAll others
Biscuits All -
MiscellaneousThickened nutritional pudding supplements -


  1. Dietitians Association of Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009.
  2. Dietitians Association of Australia and The Speech Pathology Association of Australia Ltd. Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definition. Nutr Diet 2007;64 Suppl 2:S53-76.
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