Fluid diet - mildly thick

Aim

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

Characteristics

Level 150 – mildly thick is thicker than naturally thick liquids such as fruit nectars but not as thick as room-temperature honey. Pours quickly from a cup but slower than regular unmodified fluids. May leave a coating of residue in the cup after being poured. It is designed to be drunk from a cup, but effort is required to take this thickness via a standard bore straw.

Testing scales for viscosity exist but are not formalised or standardised. Subjectively, fluids at this thickness run fast through the prongs of a fork but leave a mild coating on the prongs.

Indications

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), brain injury, head and neck cancer, 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.

Precautions

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.

Paediatrics

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

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	All	-
Sauces, gravies	All, if small amount served on food	Served in a separate jug
Starchy vegetables / pasta / rice	All	-
Vegetables	All	-
Soups	Pureed and thickened to characteristic level 150 thickness (all Band 1)	All others
Sandwiches	All	-
Salads, dressings	None	-
Breads, cereals	All breads All cereals, served with level 150 thickened milk	Milk with dry cereal
Spreads	All	-
Hot breakfast choices	All others Pureed baked beans and spaghetti	Canned baked beans and spaghetti in thin sauce
Fruit	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)
Yoghurt	All yoghurts	-
Desserts	Most others with no thin fluids, including creamy rice	Ice-cream, jelly, crème caramel (unless approved by speech pathologist)
Milk and cheese	Milk must be thickened to level 150 thickness	Milk with dry cereal
Beverages	Must be thickened to level 150 thickness	All others
Biscuits	All	-
Miscellaneous	Thickened nutritional supplements	-

References

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.