Fluid diet - moderately thick
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
To provide thickened fluids of a moderately thick consistency for patients with dysphagia for whom thinner fluids are unsafe, and to maintain fluid balance using thickened fluids.
Characteristics
Level 400 – moderately thick is similar to the thickness of room-temperature honey. It is cohesive and pours slowly. It is possible to drink directly from a cup, although fluid flows very slowly. It is difficult to drink through a straw, even if using a wide bore straw. Spooning the liquid into the mouth may be the best way of taking this fluid.
Testing scales for viscosity exist, but are not formalised or standardised. Subjectively, fluids at this thickness slowly drip in dollops through the prongs of a fork.
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), 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 400 thickness (all Band 1) | All others |
| Sandwiches | All | - |
| Salads, dressings | None | - |
| Breads, cereals | All breads All cereals, served with thickened milk | Milk with dry cereal |
| Spreads | All | - |
| Hot breakfast choices | Pureed baked beans All others | Canned baked beans or spaghetti |
| 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, 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 400 thickness | Milk with dry cereal |
| Beverages | Must be thickened to level 400 thickness | All others |
| Biscuits | All | - |
| Miscellaneous | Thickened nutritional supplements | - |
References
- Dietitians Association of Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009.
- 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.