How Often Should A 3 1/2 Month Old Nurse Thickened Drinks – What Are They, Why Are They Needed and How Do I to Make Them?

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Thickened Drinks – What Are They, Why Are They Needed and How Do I to Make Them?

As a speech-language pathologist, I am often asked questions like these by family members of people newly diagnosed with swallowing difficulties. Most people have never heard of difficulty swallowing, let alone “concentrated drinks”. Difficulty swallowing (also known as dysphagia) is uncommon but can affect people of all ages. There are many known causes of dysphagia, but some of the more common are: stroke; cerebral palsy; Parkinson’s disease; head injury; surgery and radiation therapy for head or neck cancer; and changes in the nerves and muscles of the throat that make swallowing difficult for the elderly.

What are condensed liquids and why are they recommended?

If someone you know has been diagnosed with swallowing difficulties, they’ve probably been prescribed “concentrated drinks” or “concentrated liquids.” Concentrated drinks are basically regular drinks with a specially formulated thickener added to them to make them thicker than regular drinks (more on that later in this article). Speech-language pathologists (also known as speech therapists or speech and language therapists) recommend them to people who can no longer safely swallow normal liquids and are at risk of drinks entering their lungs. Drinks entering the lungs can result in severe coughing, choking or more serious risks such as chest infection and aspiration pneumonia. I recently worked with a lady who, just four months before, had been in the hospital with her third aspiration pneumonia in less than 10 months. Over 12 months ago, he was offered concentrated drinks, but he still drank regular drinks at least once a day, and small amounts of the drinks ended up in his lungs. This was not only a problem because of the fluid in his lungs, but also because the naturally occurring bacteria in his mouth traveled with the fluid into his lungs. If this happens, it’s only a matter of time before the bacteria causes a chest infection known as aspiration pneumonia. Luckily for the lady, she finally listened to the advice and drank only the condensed drinks recommended to her. Since then, he has not had a recurrence of aspiration pneumonia!

So what’s so special about concentrated drinks? One of the reasons they work is because they travel down the throat more slowly and are easier to control when you swallow. To get a better idea, imagine: Someone starts pouring water from a cup and tells you to pour it into a bowl that you hold in your hand. He tries to answer as quickly as possible, but there will probably be a delay between when they start pouring and when he moves the bowl to catch the water. This short delay probably means that some of the water is landing on the floor. Now imagine someone pouring a concentrated drink from a cup, like a thick shake. You’ll probably absorb a lot more of that liquid because the thick shake flows out of the cup more slowly, giving you more time to react. This is similar to what happens when someone with swallowing difficulties drinks water as opposed to a concentrated drink. When they drink water, the muscles and nerves in their throats don’t work fast enough, and some of the water can end up in their lungs. But when they drink concentrated beverages, the fluid moves more slowly, giving their bodies more time to control and direct the fluid from their lungs to their stomach. This is one of the reasons why compressed fluids work. Because people with swallowing difficulties usually struggle throughout the day, they substitute normal drinks with concentrated liquids every day. This means that in most cases, people with thickened fluid cannot drink normal drinks at all, or until their speech pathologist advises otherwise. Therefore, if someone consumes concentrated drinks, try to drink as much of them as is necessary to maintain normal hydration (1-2 liters).

Three levels of compressed liquids

When someone is diagnosed with swallowing difficulties, the speech pathologist recommends one of three different thickness levels. The level of recommended thickness varies from person to person. This depends on the severity of the individual’s swallowing disorder. Typically, the worse the swallowing disorder, the thicker the drink. Recently, Speech Pathology Australia and the Dietitians Association of Australia worked together to create the Australian Standards for Formulated Foods and Liquids*. The following names and descriptions have been developed for the three recognized thicknesses of condensed drink:

Level 150 – Slightly thick

This level is the thinnest of all compressed liquids. It pours out of a cup quickly (but more slowly than regular liquids) and has a fast, steady flow. You can also drink drinks of this density from a cup. Other names used to describe the thickness are: level 1, nectar thickness, quarter thickness, cream or semi-thick.

Level 400 – Medium thick

This level is the second densest of all condensed liquids. It’s similar to the thickness of a thick shake (but a thick shake gets thinner as it melts, so people with that thickness still can’t drink a thick shake!). Drinks of this thickness pour slowly from the cup and have a slow flow. Because it is thick, the best way to drink this drink is with a spoon. Other names used to describe thickness are Level 2, Honey Thick, Semi Thick or Thick.

Level 900 – Extremely thick

This level is the densest of all the compressed liquids included in the new thickness guidelines. Drinks of this thickness cannot be poured from a cup into the mouth, as their flow rate is very low. Drinks of this thickness are so dense that they hold their shape on the spoon, so using a spoon is the best method. Other names used to describe the thickness of the drink are level 3, thick pudding, full thickness, foam or extra thick.

How can I buy or make concentrated liquids?

You have two options, you can buy pre-made condensed drinks or you can make your own condensed drinks with a powder concentrator. Many people also use a combination of the two – so they get the benefits of both options.

Pre-mixed condensed drinks

The first option is to purchase pre-mixed concentrated liquids. These are available in single-serve cups (sold individually or in cartons) or large bottles. Here are some benefits:

  • they require no preparation and are ready to drink,
  • no need to refrigerate until opening
  • they have a long shelf life (6+ months)
  • you can be sure that the drinks are made at the right thickness and are not too runny or too thick

These products are especially attractive to those who are elderly or disabled and cannot prepare the drinks themselves, or do not have someone they can trust to do it correctly every 1-2 days. The downside to prepackaged drinks is that they cost more than concentrate powder, and some brands only produce a limited number of flavors. In Australia we are lucky to have producers with over 20 flavors on the menu. However, if you do not live in Australia, you may need to search online to find the right products for you.

Make your own condensed drinks

The second option is to make compressed liquids with a special powder compactor, which can come in small cans all the way up to large economical cans. These thickeners have been specially developed for people with swallowing disorders. Thickeners such as cornmeal or Karicare are not recommended for thickening drinks. Reasons for this:

  • with these products it is difficult to get the drinks to the right consistency
  • they often change the taste of drinks dramatically
  • it can be difficult to blend in completely
  • the consistency of drinks may change (thicker or thinner) with time or with changes in ambient temperature. This can cause the drink to become diluted, too thick or sticky and therefore unsuitable for drinking.

The advantage of using a special thickening powder is that it is cheaper and more economical than buying pre-mixed drinks, and you can add it to any flavored drink (including beer and wine!!). The disadvantage of using a powder thickener is that many people, especially the elderly or disabled, have difficulty mixing the drink to the right consistency. If a drink is too runny, you risk the drink running down your throat and into your lungs. If the drink is too thick, it may not be appetizing and you may drink less of it and therefore become dehydrated. Also, pre-mixed drinks with a powder thickener only last a very short time in the fridge – usually 1-2 days.

A few final notes on dust compaction. Since not all powder thickeners can be used to thicken hot beverages (and you think you want to thicken hot beverages like tea), be sure to look for this information when choosing one. Also, if you decide to buy a special thickening powder, you can find the recipes on the back of the container. They are fairly easy to find and follow. Each package usually contains three recipes that describe how to prepare the drink for each of the three recommended thickness levels. For example, if you are at level 150 – slightly thick, the recipe may tell you to add 1 teaspoon of powder to 200 ml of liquid, then mix. Remember, if you’re not sure which thickness level applies to you or a family member, don’t guess, as it can be risky for the drinker – especially if the drink is too thin. Just ask your dietitian or speech pathologist.

As you can see, there are a few things to understand about using and making condensed drinks, but there are many options to choose from and you just need to find what works for you or your family in terms of price, ease of use and taste.

References: *Dietitian Association of Australia & The Speech Pathology Association of Australia Limited (2007). Texture-modified foods and condensed liquids in patients with dysphagia: Australian standard labels and definitions. Nutrition and dietetics64 (Supplement 2): 553-576

(c) Copyright – Katie Prendergast. All rights reserved worldwide.

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