This newsletter is a joint collaboration between Adult Speech Pathology and Nutrition Professionals Australia.

MILDLY THICK, Pink, Level 2

There is no change to Mildly Thick fluid  level.
It is sippable and pours quickly from a spoon, but slower than 'thin' drinks.

It requires effort to drink through a standard straw.

Mildly thick fluids may be suitable for people with slightly reduced tongue control.


Slightly thick is a new fluid level.

It is thicker than water, but it flows through a straw or syringe.

It is used mainly with children, but you might start to see this thickness being requited in aged care. It is unknown whether the adult thickener companies will produce this thickness in their ready to drink range.

THIN, White, Level 0

Thin fluids have a fast flow rate. They flow like water.

This is NOT a thickened fluid, and does not require thickening.

NOTE: All thickened fluids must be referred to by at least two identifiers:

(colour & name/ name & number / number & colour) e.g. Mildly thick, Level 2, Pink


IDDSI recommend using the IDDSI Flow Test as a practical and objective method of classifying the thickness of drinks and liquidized foods.

Fluids can be catergorised according to their 'flow rate' (how quickly or slowly they move).
The IDDSI Flow test is a gravity flow test using a 10ml syringe. It is based on how much of the 10ml of the fluid is left after 10 seconds of flow.

This test is useful for drinks and liquids in Levels 0-3 (Thin fluids - Moderately thick / liquidised), such as gravy, sauces and nutritional supplements.

Extremely thick drinks (level 4) do not flow through a 10mL syringe in 10 seconds, and other testing methods are recommended (e.g., the IDDSI Fork Test and/or Spoon Tilt Test. Please see previous newsletters for more information).


*Note* The IDDSI Flow test use a 10mL slip tip hypodermic syringe.


How do the current Australian Standards for thickened fluids
correspond to IDDSI and the IDDSI Flow Test? 

Here's an overview.


Straws and spouted cups should be used with caution and with clear rationale. While they may have benefits for certain individuals, they may actually increase the risk of aspiration for many individuals with dysphagia.


Straws and spouted cups can be good for people with physical limitations to enable them to access drinks more independently. They may also help some people with poor lip seal to reduce spillage.

When drinking from a straw the person is encouraged to drink with their chin slightly flexed, which can help to protect the airway.

Straws can assist some people who have trouble moving the bolus from the front to the back of the mouth to trigger the swallow. The straw delivers the bolus to the 'swallow trigger spot' at the back. (This assumes that the person's swallow reflex itself is still adequate.)      

The person with good cognition and dexterity can control the mouthful size delivered from the cup or via the straw, which can make swallowing more predictable and manageable.


Some individuals don't have enough respiratory capacity to suck. Others can't control sucking, so either take too little or too much and risk losing control. (Those with cognitive decline may lose control here.)

Some individuals can't coordinate sucking with swallowing, which can cause aspiration.

As straws deliver the bolus towards the back of the mouth, many people with dysphagia cannot swallow quickly enough when the liquid arrives, leading to increased risk of aspiration.

Fluids via straw are often offered when individuals are poorly postured or even lying down, which definitely    increases aspiration risk.
People often have to extend their head/neck when drinking from a spouted lid causing the airways to be more open therefore can increase the risk.This is a text block. You can use it to add text to your template.


Older people who reside in aged care homes are particluarly vulnerable to dehydration for many reasons including poor intake, increased fluid loss, dementia, medical conditions, and potentially poor awareness of staff in assisting fluid intake.

It is generally recommended that older people take a minimum of 500-2000ml/ day. One way of calculating reequiremtns wis to use the following formula:

  • 100ml fluid/ kg body weight for first 10kg
  • 50ml fluid/kg for next 10kg
  • 15ml fluid/kg for each kg after 20kg

This equates to 2000ml for a 50kg individual and rises to 2600ml if they weigh 90kg. Many people do not drink this amount, but remember that the requirement includes all fluids- not just what the person drinks but also the fluid that is a part of food eg stews, soups, custard, stewed fruit etc.

Tips for improving fluid intake:

  • Train all staff in the importance of maintaining an adequate hydration
  • Offer fluid frequently- every 1 ½ hours
  • Consider a hydration cart that includes a wide variety of fluids
  • Offer additional fluids all events/ meals/ snacks
  • Offer a variety of fluids/ preferred fluids- check with the resident what they would like to drink at the time
  • Keep fluids within reach- eg a water fountain, jugs at the bedside
  • Offer extra drink rounds in the hot weather
  • Prompt the person to drink frequently
  • Try 'Here is your drink' rather than 'Would you like a drink'? as the answer may be a resounding "No"
  • Intake for at risk residents may required documentation via a Fluid Intake Chart.

Residents requiring thickened fluids and those who are dependent on staff for all of their nutrition and hydration needs tend to drink less and will need particular attention to ensure an adeqate intake. Staff need sufficient time allocated to ensure that all residents will drink sufficient.


We have set the dates for the 2019 Improving Nutrition 2 day seminars. See the website for more details and for the dates in your region.

This year we will be focussing on IDDSI and the new standards.


NPA's new Meal Plans Manual is a benchtop guide to nutrition care and therapeutic or special diets when catering for older people.

It provides a summary of nutrition for an older person, information regarding menu planning as well as a meal plan for each of the various special diets that are likely to be encountered. 

Many of these special diets eg diabetic and texture modified diets are routinely provided from the main menu, but others will need to be catered for on an individual basis.

The meal plans provide a simple and practical guide that can be readily referred to at the time of serving meals.

Also included in this manual is information regarding standard serve sizes and a standard menu structure to ensure that residents are provided with ample opportunities to choose foods from each of the core food groups and to ensure that the organisation meets Best Practice and/ or Accreditation Guidelines.



Online e-learning Presentations

Have you attended NPA's Improving Nutrition in Aged Care Seminar? We are now offering the seminars as a series of online e-learning presentations.

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Resources for Aged Care

NPA has developed a set of resources and information for aged care homes.They have recently been upgraded- both the content and the look and feel of the resources.You can begin accessing them from our website now. 

Read more