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Dysphagia and thickeners

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This information reflects new International Dysphagia Diet Standardisation Initiative (IDDSI) guidelines.

These were adopted from 1 April 2018.

‘Dysphagia’ refers to difficulty with swallowing. Causes include:

  • an abnormality in the oesophagus
  • obstruction from external compression
  • a stricture or difficulty in initiating the swallowing process

Solids and liquids cannot move out of the mouth properly. Incidence of dysphagia increases in people with:

  • dementia
  • stroke
  • Parkinson’s disease
  • head and neck cancers
  • motor neurone disease
  • brain injury
  • learning disabilities

Symptoms and complications

These can include, but are not limited to:

  • coughing, hoarseness
  • discomfort, pain
  • inability to control food or saliva, drooling
  • weight loss
  • dehydration
  • malnutrition
  • chest infections, aspiration pneumonia
  • choking
  • death

Why use thickeners?

Thicker liquids may help people with dysphagia to improve the control of the movement of a food bolus.

This allows more time for the closing of the entrance to the trachea (windpipe). And it reduces the risk of aspiration.

How thick?

The IDDSI developed the following descriptors and guidelines. BDA (The Association of UK Dieticians) and RCSLT (Royal College of Speech and Language Therapists) adopted them.

Diagram showing the International Dysphagia Diet Standardisation Committee framework

The Francis Report highlighted the importance of giving people food and fluid in a form they can safely consume. It forms part of NICE Clinical Guideline CG68.

Scoop sizes

From 1 April 2018 manufacturers launched preparations with the revised guidance on them. This may include different sized scoops. These might not correspond to the directions from the Speech and Language Therapy (SALT) team.

Different manufacturers of thickeners are taking different approaches. This will impact on the availability of stocks after 1 April 2018.  The size of scoop contained within the tin will correspond with the revised classifications.

Each brand uses a different number of scoops to achieve the described consistency.

You'll need to update care plans and other documents to reflect the changes.

You may have existing stocks of pre-April thickeners. These might not have instructions and scoops that correspond to the revised guidance.

Risk assessed, safe storage is essential. Patient Safety Alert: Thickening Powders

Important questions to consider

Have all people who need a thickener had an appropriate assessment?

Do people that need thickeners have care plans for dysphagia? Are the current consistency recommendations recorded?

Are they only used for the people they are prescribed for?

Are staff, including kitchen staff who prepare foods, trained on the use of thickeners?

Are medicines thickened if needed?

Where is the use of thickeners recorded? How is it monitored?

Do staff know how to spot warning symptoms such as dehydration and chest infections? See fluid administration charts

Last updated:
27 January 2020