Thickened water is a medical intervention designed to improve swallowing safety for individuals experiencing dysphagia, a condition characterized by difficulty or discomfort in moving liquids and food from the mouth to the stomach. Thin liquids, such as regular water, move quickly and can be misdirected into the airway, a complication known as aspiration, which can lead to serious respiratory issues. By increasing the viscosity of water, the fluid’s flow rate is slowed down, providing the muscles in the mouth and throat more time to coordinate a safe swallow. This texture modification is a crucial strategy for maintaining hydration while significantly reducing the risk of aspiration.
Choosing the Right Thickener
Commercial thickening agents are powder-based formulations made from modified corn starch or natural gums, typically xanthan gum. Starch-based thickeners operate by making the starch granules swell as they absorb water, creating a cloudy appearance and sometimes a slightly grainy texture. A drawback of starch is that it can be broken down by amylase, an enzyme present in saliva, causing the thickened liquid to thin out in the mouth and potentially increase the risk of an unsafe swallow.
Gum-based thickeners, commonly utilizing xanthan gum, form a stable molecular network that traps water molecules, resulting in a clearer appearance and a smoother texture. These thickeners are not affected by salivary amylase, meaning the desired consistency remains stable from preparation through consumption. Gum-based products maintain their viscosity consistently across a wider range of temperatures and over time. Because they are more stable, they require a smaller amount of powder to achieve a specific thickness level compared to starch-based options, preserving the water’s natural taste.
Understanding Standardized Thickness Levels
The correct thickness level is a precise safety requirement that must be determined by a healthcare professional, such as a speech-language pathologist. A global framework provides standardized terminology and testing methods for classifying liquid consistency. The levels are defined by how quickly the liquid flows, a measurement that directly correlates to the speed at which a person can safely swallow.
Liquids are classified into several distinct levels, ranging from water to a spoon-thick consistency. The levels relevant to drinking water include Slightly Thick, the thinnest thickened level, which flows relatively easily through a straw. The next level, Mildly Thick, is comparable to the consistency of fruit nectar and pours slowly off a spoon.
Moderately Thick and Extremely Thick
Moderately Thick liquids resemble the consistency of honey, moving slowly off a spoon and generally requiring significant effort to drink through a straw. The thickest level, Extremely Thick, is similar to a pudding or custard consistency, holding its shape and requiring consumption with a spoon. Using a level that is too thin can still lead to aspiration, while a level that is too thick may cause residue to remain in the throat, which can also be aspirated later.
Step-by-Step Preparation Methods
Accurate preparation begins with selecting the correct ratio of powder to water, based on the prescribed thickness level and container instructions. Use the measuring scoop provided with the product to ensure precise dosing for the volume of water being thickened. The powder should always be added to a clean, dry cup or glass first, before introducing the liquid.
The water should then be added quickly to the powder, followed immediately by rapid stirring with a fork or whisk for approximately 15 to 30 seconds. This mixing technique is necessary to dissolve the powder completely and prevent clumping, which results in an inconsistent texture. After mixing, the thickened water requires a standing time, typically between one and four minutes, to allow the thickener to fully hydrate and achieve its final consistency.
If the final product appears too thin, a small, measured amount of additional thickener can be mixed in after the initial standing time, though starting fresh is better to maintain consistency. If the water is prepared in a large batch, a blender or shaker bottle can be used to ensure thorough mixing. Issues with clumping or a delay in thickening may be caused by factors like water temperature or acidity, sometimes requiring a slight adjustment to the powder amount.
Safe Handling and Storage
Once the water has been thickened to the correct consistency, it must be stored and consumed safely. The thickened water should be consumed within a recommended timeframe, as viscosity may change over many hours, particularly with starch-based products. Generally, thickened liquids should not be left at room temperature for more than three to four hours before being discarded.
If a large batch is prepared, store it immediately in a sealed container in the refrigerator, where it remains stable for up to 24 hours. Before serving refrigerated thickened water, briefly stir it and check its consistency to ensure it still meets the required safety level. Ice cubes made from regular water will melt and dilute the thickened liquid, returning it to a thin, unsafe consistency, so only thickened liquid should be used to make ice.