Fluid diet - moderately thick level 3
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
Provide fluids of a moderately thick (IDDSI level 3) consistency for patients with dysphagia as recommended by a speech pathologist.
Characteristics
Moderately thick – level 3 can be consumed from a cup, although fluid flows very slowly. No oral processing or chewing is required. It is free of lumps and it can be swallowed directly. Moderate effort is required to suck through a standard bore or wide bore straw (standard bore straw = 5.3mm diameter, wide bore straw = 6.9mm diameter). The best way of having this fluid is to use a spoon.
Refer to The International Dysphagia Diet Standardisation Initiative 2016 for approved IDDSI testing methods.1
IDDSI compliant – moderately thick – level 3 commercial products are labelled with a yellow triangle identifier.*
Indications
Swallowing disorders as identified by a speech pathologist.
Nutritional adequacy
Care must be taken to ensure adequate fluid intake when patients require a thickened fluid diet. Patients on this diet should be monitored regularly to ensure adequate fluid and nutritional intake.
Precautions
Ensure the patient does only receives fluids of the consistency recommended by the speech pathologist.
Paediatrics
Suitable for use in paediatrics when combined with an age-appropriate diet (if indicated).
Specific menu planning guidelines
Allowed | Not allowed | |
---|---|---|
Hot main dishes | All. But wet dish sauces need to be assessed as compliant by a speech pathologist | Wet dishes with thin sauces |
Sauces, gravies | All, only if a small amount is served on food (max 40ml serving) | Served separately |
Starchy vegetables / pasta / rice | All | - |
Vegetables | All | - |
Soups | Thickened to moderately thick – level 3 consistency or deemed already suitably thick and assessed as compliant by a speech pathologist | All others |
Sandwiches | All | - |
Salads, dressings | Salad ingredients and vegetables that produce minimal juice when eating (e.g. carrot, lettuce) Salad dressing needs to be assessed as compliant by a speech pathologist | Thin dressings Salad ingredients and vegetables that produce juice, e.g., pineapple, orange, tomato |
Breads, cereals | All breads All cereals served with milk thickened to moderately thick – level 3 consistency | Milk with dry cereal |
Spreads | All | - |
Hot breakfast choices | All, except those listed as not allowed | Grilled tomato Caution to be applied to canned baked beans, canned spaghetti or porridge. Sauces and liquid need to be assessed as compliant by a speech pathologist |
Fruit | Drained canned fruit Fresh fruit that produces minimal juice when eaten, e.g., banana, apple Dried fruit | Undrained canned fruit Fresh fruit where juice is produced when eaten, e.g., orange, watermelon, passionfruit, pineapple |
Yoghurt | All yoghurts | Drinking yoghurt |
Desserts | All, but sauces need to be assessed as compliant by a speech pathologist Thick custard | Transitional desserts, meaning desserts that change to a liquid in the mouth, e.g., unthickened ice-cream, jelly |
Milk and cheese | Milk thickened to moderately thick – level 3 consistency All cheese | - |
Beverages | Must be thickened to moderately thick – level 3 consistency | All others |
Biscuits | All | - |
Miscellaneous | Nutritional supplements thickened to moderately thick – level 3 consistency | - |
Celebratory foods / special occasions | Not applicable | Not applicable |
*©The International Dysphagia Diet Standardisation Initiative 2019 licensed under the Creative Commons Attribution ShareAlike 4.0 License. Derivative works extending beyond language translation are NOT PERMITTED.
References
- International Dysphagia Diet Standardisation Initiative. Complete IDDSI Framework Detailed definitions. IDDSI; 2019. [cited 19 August 2022].