IDDSI Liquid Levels. Framework pyramid showing liquid levels from IDDSI.org in photo outline on the left with a pitcher pouring a thin liquids. The levels include thin, slightly thick, mildly thick, moderately thick and extremely thick. dysphagiadietitian.com

All About IDDSI Liquid Levels (0-4)

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How Many IDDSI Liquid Levels Are There?

The IDDSI Framework is designed to help people with swallowing disorders manage their food and drinks safely. These disorders are otherwise known as Dysphagia. People with Dysphagia have difficulty getting food and drinks comfortably and safely from their mouths to their stomachs.

Dysphagia can happen for any number of reasons. These include neurological disorders like Parkinson’s and Multiple Sclerosis, muscular disorders (muscular dystrophy), GERD, cancer, and many more.

The IDDSI Framework was developed to classify thicknesses of liquids and altered textures of foods for managing difficulty swallowing. IDDSI Liquid levels get thicker as the numbers increase (0-4). A Speech Therapist (or careful trial and error) will help you determine which levels are right for you.

Liquids are very important because the speed of your muscles determines which level is safest for you. Liquids move very fast, so thickening them slows them down so that your muscles can keep up. So what are the levels for liquids?

IDDSI Level 0 – Thin Liquids

Thin liquids are also called level 0, they are unchanged. This would be juice, water, soda, or any other beverage of your choice. The majority of drinks are considered thin. This liquid level is included in the framework to set a baseline for how liquids normally act.

Firstly, this liquids moves very quickly and does not stay on a spoon very well or for very long. These liquids behave the way you would expect. The problem is, for people who have poorly coordinated mouth muscles, or weak muscles, these liquids might be hard to manage which can be risky.

Some symptoms of poor control with thin liquids may include coughing when drinking, losing liquids out of the mouth through the lips, and aspiration pneumonia. For those that have trouble with thin liquids, adding thickener may be the best solution.

IDDSI Level 1 – Slightly Thick Liquids

Slightly thick liquids are barely thicker than water. They usually have a small amount of a powdered or gel thickener added to a thin liquid like water or juice. Choosing a thickener product that you like is a matter of trial and error. Keep trying different options until you find one that you like.

(Many companies will send samples so you don’t have to purchase an excess amount of thickener before finding your favorite)

These slightly thickened liquids will still flow easily through a straw but require a little bit more strength and effort than a thin liquid. Some liquids may be naturally slightly thick. These may include:

  • fruit nectar including tomato juice
  • Some milks that contain fat (dairy and non-dairy)
  • Some ice creams

Furthermore, if you need to learn how to test your liquids for correct thickness, check out this video on YouTube.

IDDSI Level 2 – Mildly Thick Liquids

Similarly, mildly thick liquids start as thin and have a bit of thickener added to them. Very few liquids are naturally mildly thick, although some fruit nectars and full fat milk may naturally be the right consistency.

These liquids still flow off a spoon but much slower than normal. They can be sucked through a straw which will require some effort and muscle strength.

IDDSI Liquid Level 3 – Moderately Thick Liquids

Moderately thick liquids, known as IDDSI Level 3 are not typically naturally occurring. You will need to start with a thin or slightly thick liquid (like tomato juice), and add a powdered or gel thickener and then blend, stir, or shake. Follow the instructions on the thickener packet for preparing your drink.

Level 3 liquids will likely still be able to flow through a straw (although it may be a larger diameter straw) with effort. The cheek muscles will probably get a workout getting your drink through your straw. These liquids can be drunk from a cup or sipped from a spoon (think thick stew consistency).

IDDSI Level 4 – Extremely Thick Liquids

Extremely thick liquids are also called Level 4. They used to be called Pudding Thick. These liquids do not have very much movement. They drop, or dollop, off a spoon and have no flow to them.

In addition, characteristics of these liquids include:

  • Can be eaten off a spoon or fork without falling off
  • Not easily poured from a cup
  • Smooth with NO lumps
  • Too thick to be sucked through a straw
  • They hold their shape
  • Not sticky.

Lastly, level 4 liquids are for people who have more strength and less coordination with their mouth muscles. This low coordination can lead to poor control of a thin or thinner liquid which requires the liquid to move very slowly for safety. This can increase risk of aspiration (liquids going into the lungs by accident).

Conclusion of IDDSI Liquid Levels

Summing up, there are 5 different levels for thickened liquids. Each levels was developed to help different people who have trouble swallowing drinks that move fast, depending on their specific difficulty. The level you need may change over time. Be sure to follow up with your doctor and speech therapist if anything about your swallowing changes.

If you are needing extra help figuring out what liquid level is safest for you, please send me a message or book a call HERE for gaining clarity about your recommended liquid level. Good luck, stay safe and hydrated while drinking your liquids!

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