I’m not drinking that, it’s wallpaper paste!

What’s up with thickeners?

The use of thickeners is a compensatory measure. They’re for pulmonary safety rather than swallow rehabilitation.

Most thickeners are now gum-based rather than starch-based. Why? Well, the starch-based thickeners aren’t amylase resistant. This meant that if a person with dysphagia held the thickened drink in their mouth for longer than usual, the enzyme amylase produced in the saliva, would break down the starch and… make the drink thinner!

I’ve often wondered if some people with dysphagia ended up on really thick drinks because they were ‘holding’ and by the time they swallowed it, it was about right. Ugh.

The gum-based thickeners solved that problem. And they look slightly better given that they’re clear.

Some of the prescribed thickeners you may have come across include;

and not on prescription;

When mixing up a prescribed thickened drink, always follow the instructions on the tin. Not to do so means that you could place the person with dysphagia at risk of chest infections or pneumonia, or dehydration if they continue to refuse the thickener as it’s not mixed right.

Prescribed gum-based thickeners should be mixed like this;

  • note the IDDSI Level recommended by the speech and language therapist and how many scoops per how many mls this is
  • place the number of flat scoops into the dry shaker / cup / glass first
  • if you are making a hot drink, don’t use a shaker, and do make up the drink as normal in a cup or mug
  • pour the drink onto the powder
  • if it’s a cold, still drink, then shake or if it’s any other drink or you have no shaker, stir with a small whisk, fork or spoon
  • stir for as long as the thickener instructions tell you to and making sure it’s all dissolved
  • leave the drink to complete thickening for as long as the thickener instructions tell you to – many people miss this out and serve immediately

For Slõ drinks, you simply add the sachet to the drink and stir. Done!

Carry out regular IDDSI audits to see if the drinks are being thickened correctly using the IDDSI audit sheets.

Even better, and much more practical, check each drink as you go. You can do this quickly and easily with Viscgo sticks. And if you’re a speech therapist, dietitian or dysphagia practitioner and are interested in the challenges of thickened drinks, sign up to the free webinar by Dr Ben Hanson, hosted by Sandra.

If the drink is an incorrect consistency or has lumps of powder still in it that won’t dissolve – throw it away and start again!

For anyone with dysphagia, enjoying their drinks is important for quality of life. By simply following instructions and not making assumptions about how to do it, you’ll significantly improve the drinks and heighten the person with dysphagia’s enjoyment of those drinks.


Published by Sandra Robinson

Independent Speech and Language Therapist. Specialist Dysphagia Practitioner.

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