Thickened Liquids With Dysphagia (Part II)

Patients who have difficulty swallowing (dysphagia) are often prescribed thickened liquids to lessen the risk of aspirating fluid into their lungs. The intended purpose of this two-part essay is to discuss the issue of thickened liquids for dysphagic patients. Nurses Announcements Archive Article

Thickened Liquids With Dysphagia (Part II)

Dysphagia is a medical word that refers to difficulty swallowing. Patients who have dysphagia are at a heightened risk for developing aspiration pneumonia since the foods and fluids that they consume might accidentally enter their lungs. Since these patients have chronic swallowing problems, the physician or speech language pathologist (SLP) might recommend thickened liquids.

Removing all thin liquids from the diet and introducing thickened liquids might help dysphagic patients by minimizing the chance for fluids to seep into the lungs, reducing the risk of choking, and increasing the opportunity for adequate oral hydration.

Thickened Liquids With Dysphagia (Part I) of this two-part essay discussed oropharyngeal dysphagia and described the different textures of thickened liquids. You are now reading part two, which will focus on guidelines for patients who have been prescribed thickened liquids.

All liquids, including soups and broths, will need to be thickened from now on. Most physicians and SLPs will caution dysphagic patients against using straws because they might lead to choking or even more trouble with swallowing.

Dysphagic patients should also avoid consuming juicy foods such as oranges and food items that melt such as ice cream. According to UPMC (2012), stay in an upright position while drinking and for 15 to 30 minutes afterward. It is also recommended that dysphagic patients continue to drink six to eight glasses of fluids on a daily basis unless a strict fluid restriction has been ordered.

Pre-thickened drinks and commercial thickening agents may be purchased at drugstores, medical supply stores, pharmacies, and online. Most commercial thickeners include directions for getting the right consistency (UPMC, 2012).

In the event that the commercial thickening agent has unclear or no directions, the guidelines are as follows. Nectar thick consistency can be achieved by mixing 1 1/2 teaspoons of thickener with 1/2 cup of thin fluid, honey thickness can be achieved by mixing 1 1/2 tablespoons of thickening agent with 1/2 cup of thin liquid, and the pudding consistency can be reached by stirring two tablespoons of thickener with 1/2 cup of liquid.

Mix the thickener into the liquid for 20 seconds and let it sit for two minutes because the fluid will need a little time to become thick. Keep in mind that hot liquids will become even thicker during the cooling process, and sodas will lose carbonation while being thickened. Liquids that have become too thick can be thinned out by adding some thin liquid, and a small amount of thickening agent may be added if the liquid is too thin. However, do not make the liquids thinner than recommended. It's better to drink a liquid that is too thick than too thin (UPMC, 2012).

Since dysphagia is prevalent in healthcare settings, it is important that nurses and other healthcare workers know all about thickened liquids. Knowledge is power, and together we can educate our patients and their families to assist in maintaining peoples' safety.


TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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Specializes in Gerontological, cardiac, med-surg, peds.

I understand the need for thickened liquids to help prevent deadly aspiration pneumonia and chemical pneumonitis. However, I do feel sorry for the patients who have to suffer the ordeal of this type diet. The liquids are all nectar consistency and often do not taste the same as before. Therefore, these patients often avoid drinking liquids and are at risk for dehydration. They are also at risk for chronic constipation problems.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
However, I do feel sorry for the patients who have to suffer the ordeal of this type diet.
I feel sorry for them, too. A major part of one's quality of life is the ability to enjoy pleasurable food and drink. I've consumed thickened liquids out of curiosity, and they feel rather strange while going down. Also, you are correct when you say that a thickened beverage does not quite taste the same.
Specializes in LTC and School Health.

Thank you Commuter!!!!!

Just a few responses

According to UPMC (2012), stay in an upright position while drinking and for 15 to 30 minutes afterward (This would only be the case if the patient had significant pharyngeal residue after the swallow, or esophageal regurgitation, this should be a case by case basis and not applied to every patient with dysphagia).

However, do not make the liquids thinner than recommended. It’s better to drink a liquid that is too thick than too thin (UPMC, 2012). This is NOT universally true. There are many patients that may be able to tolerate a nectar thick liquid, but would still aspirate honey thick liquids or even pureed foods, so in their case, thicker may not be safer! Please follow the recommendations from your speech language pathologist.