Thickened Liquids

Thickened apple juice on the left and regular water on the right in clear cups on natural wood colored table.

People with swallowing trouble (dysphagia) may have increased difficulty drinking thin/regular fluids. Thickened liquids can improve the ease and safety of swallowing. 

This article will explain who may need thickened drinks and pros vs cons of thickened fluids. 

*This article contains affiliate links. I may earn a commission from qualifying purchases at no extra cost to you. 

What are Thickened Fluids?

Thickened fluids are beverages that have a powder or gel added to them to make them more viscous. 

They can be bought pre-thickened or thickeners can be purchased and added to preferred drinks. 

Gel thickeners tend to be more palatable. My personal favorite among patients is SimplyThick, which can be ordered in bulk right from Amazon.

*This article contains affiliate links. I may earn a commission from qualifying purchases at no extra cost to you. 

Thin liquids can slide too quickly to the back of the throat and into the airway (1). This is called aspiration, which can lead to pneumonia. 

Thicker fluids flow slower, so they can be easier to manipulate in the mouth and to swallow. They are less likely to go into the lungs. 

Increased viscosity can also increase sensory awareness of the fluids in the mouth (2). This can be beneficial for those with cognitive impairment.  

Levels of Thickened Liquids

Regular, thin, or water-like fluids are the drinks you typically consume on a daily basis. 

Beverages can be thickened to various consistency levels depending on the severity of someone’s dysphagia. 

Gel or power thickening agents are available with instructions to thicken drinks to indicated levels. 

Thickened liquids can also be purchased pre-thickened. Some find these more palatable, however beverage choices would be limited to what is available commercially. 

*This article contains affiliate links. I may earn a commission from qualifying purchases at no extra cost to you. 

Slightly Thick Liquids

Slightly thick liquids are fluids that are naturally, slightly thicker than regular fluids. Examples include smoothies, fruit nectars, and some oral nutrition supplements. 

Mildly Thick Liquids 

These were previously referred to as nectar thick liquids. Mildly thick liquids are the new terminology from the global initiative IDDSI.  

These fluids are able to flow off of a spoon, however more slowly than regular fluids. 

If straws are safe for use, mildly thick fluids can be sucked through a straw with some effort. 

Moderately Thick Liquids

These fluids were previously called honey thick liquids, until the shift to universal dysphagia terminology. Read “IDDSI Explained” to learn more about this shift. 

Moderately thick fluids are thicker than mildly thick drinks. They need to be consumed from a cup or with a spoon. 

Extremely Thick Liquids

Extremely thick fluids were previously referred to as pudding thick. They must be consumed with a spoon because they are too thick to drink from a cup. 

They do not require any chewing and should be smooth, but not sticky. 

List of the levels of thickened liquids: slightly thick, mildly thick, moderately thick, extremely thick.
Levels of Thickened Liquids

Who Needs Thickened Drinks?

Dysphagia is difficulty swallowing. It can lead to choking, aspiration pneumonia, malnutrition, dehydration, weight loss, and even death (3)

Swallowing trouble can result from several disease processes and health conditions.

This includes dementia, Parkinson’s, degenerative diseases, strokes, head/neck cancers, and anatomical changes. 

Signs of Dysphagia

Here are some signs and symptoms that your loved one may be having difficulty swallowing regular fluids (4):

  • Coughing during or after drinking
  • Choking
  • Spillage of liquids out of the mouth 
  • Drooling
  • Wet voice
  • Runny nose
  • Complaints of pain when swallowing
  • Reflux 

There is also “silent aspiration,” which is when food or fluids are going into the lungs without any outwardly visible signs that it is occurring. 

If dysphagia is suspected, contact the healthcare provider or a speech therapist. 

Altering the texture of foods and fluids can help if dysphagia is the problem. 

Thicker fluids move slower, so are less likely to enter the airway. While they may improve safe swallowing, thickened liquids are not without their downsides. 

Pros and Cons

Like everything, there are pros and cons of thickened liquids. 

Pros of thickened liquids:

  • More control when swallowing. 
  • Easier to swallow.
  • Reduced choking. 
  • Decreased risk of aspiration. 

Cons of thickened liquids:

  • Thickened liquids may leave more residue in the mouth and throat (5). This could lead to aspiration after drinking (6)
  • The increased starch content from the thickener can cause early fullness and lead to reduced intake (7)
  • Increased thickness can negatively impact taste. This can lead to decreased fluid intake and dehydration. 
  • Thickness may be inconsistent across settings depending on who thickens them and type of thickener used (8)

Practical Takeaways

Thickened liquids are commonly used for dysphagia treatment. They are easier to swallow and can reduce choking and aspiration. 

They are not without potential negative impacts like decreased fluid intake, dehydration, and oral residue, which could be aspirated. 

If your loved one is having signs of dysphagia consult their healthcare provider or speech language pathologist (SLP). 

Get my personal favorite gel thickener delivered right to your house from Amazon.

*This article contains affiliate links. I may earn a commission from qualifying purchases at no extra cost to you. 

Check out these other articles to learn more about dysphagia and altered diets

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