IDDSI (International Dysphagia Diet Standardisation Initiative) Level 4 – Extremely Thick Fluids

Why are my fluids being thickened?

Changing the consistency of your drinks can help to reduce the risk of swallowing complications, such as aspiration pneumonia, a type of chest infection. Slightly thick fluids are recommended when thin liquids flow too quickly for you to swallow safely. This gives the muscles more time to work and reduces the risks of the fluid going the wrong way.  You may cough or splutter when drinking, or get recurrent chest infection, and this may be a sign the fluid has gone the wrong way (aspiration). 
Graphic showing use of Resource ThickenUp Clear powder

How do I use Resource ThickenUp Clear powder?

For extremely thick fluids, use six scoops of ThickenUp Clear per 200ml of fluid. If you are using a different brand of thickener please refer to the instructions on the tin.

How do I know if my drink is the correct consistency (Level 4 extremely thick)?

  • they need to be swallowed from a spoon, they cannot be drunk from a cup or straw
  • do not require chewing
  • has a smooth texture with no lumps
  • must hold that shape on a spoon and fall in a single mass when the spoon is tilted
  • should not be sticky in consistency.

Some thick smoothies and milkshakes may be at this thickness level already, but other drinks will need thickening powder added to reach the correct consistency.

Can I thicken supplements?

Do not add thickener to nutritional supplements. Please consult a speech and language therapist or dietitian if you have any concerns about whether your oral supplements are suitable for people needing Level 4 extremely thick fluids.

Does this affect what I can eat?

If you are on texture-modified fluids (thickened drinks) you should avoid ice-cream, jelly, thin soups  and cereal with milk. This is because these foods either contain thin fluids or melt down to a thin fluid consistency.

Who should I contact if I have a problem or question?

If you have concerns regarding swallow safety or aspiration, contact your GP who can put you in  touch with your local community speech and language therapy team.

What should I do in case of an emergency?

Contact your GP or call 111 if non-urgent. Attend A&E or call 999 if an emergency.