IDDSI Level 2 Liquids - Mildly Thick liquids. International Dysphagia Diet standardisation initative. Light background with picture in middle of 5 different colored smoothies (pink, orange, yollow, lighty orange, green) and fruit on the table.

What Is IDDSI Level 2 on the New Dysphagia Diet Framework?

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IDDSI is the International Dysphagia Diet Standardisation Initiative, it was developed in 2018 to address inconsistencies with the National Dysphagia Diet. The NDD has 4 levels of solids and 4 levels of liquid thicknesses.

IDDSI level 2 describes mildly thick liquids. These liquids are similar to NDD’s nectar thick liquids.

Mildly thick liquids should still run off a spoon and will pour out of a cup easily.

IDDSI Framework. Upside down pyramid with level 7 regular & easy to chew food, level 6 soft and bite-sized, and level 5 minced and moist. Left side shows these food as transitional. Level 4 is connected to a right side up pyramid that has (left) pureed food linked to (right) extremely thick liquids, level 3 is liquidized food (left) linked to moderately thick liquids (right side). Level 2 liquids are middle of pyramid on the right as mildly thick, level 1 as slightly thick, and level 0 on the bottom as thin liquids

Why Thickened Liquids?

Thickened liquids can be helpful for people that are struggling to manage thin liquids like water without excess coughing or choking. This can happen with a condition called Dysphagia.

Dysphagia is a phenomenon that can occur with neurological impairments like Parkinson’s disease and ALS, as a symptom after a stroke or or other brain injury, or may even occur because of acid reflux or anxiety.

Dysphagia may be short term or long term, intermittent or constant. Every person is different and has different needs when it comes to changing the texture and thickness of food and drink.

Being able to safely consume liquids is very important for staying hydrated. Having liquids at the right consistency and thickness can make all the difference in feeling your best.

Mildly Thick Liquids, IDDSI Level 2 Thickened Liquids

Mildly thick liquids typically 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 be naturally the right consistency.

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

Follow the instructions that are provided with your preferred thickener to get the correct thickness. But how do you know for sure that it is the right thickness?

Testing For The Right Thickness

Using the flow test developed by IDDSI will provide you with information about the correct thickness of your liquids.

After you have prepared your liquid according to the directions of your thickener, use a flow test funnel or 10 mL syringe to test your liquid using the Flow test. Level 2, mildly thick liquids, will have between 4 and 8 ml of liquid remaining in the funnel after 10 seconds.

***Not every 10 mL syringe available will work correctly*** Be sure to find one that looks similar to the Flow test funnel. Each ml mark should be visible on your syringe.

Your drink may need to be adjusted (adding more liquid or thickener). This is because all liquids and thickeners interact a little bit differently. Be sure to let your liquid rest for the recommended time before testing or drinking. Thickeners take time after mixing to reach the correct consistency.

Conclusion of IDDSI Level 2 Liquids

Mildly thick liquids, otherwise known as Level 2 on the IDDSI framework, are appropriate for some people with Dysphagia. Finding the right thickness for your swallowing ability may require trial and error. Having the right support system can be invaluable.

A Speech Therapist and Dietitian can help tremendously when finding the safest food and drink options for you. If you have questions or need additional support send me a message by clicking HERE or on the Contact link above!

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