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Why do I need thickened drinks?
Your Speech and Language Therapist (a person with specialist knowledge of swallowing problems) has assessed your swallowing and has advised you to thicken your drinks so that they are safer and easier for you to swallow.
If you’re having swallowing problems, drinking liquids can be more difficult than eating because liquids move more quickly in the mouth and throat, so they are harder to control. Imagine how hard it is to hold water in your hands – it runs and spills everywhere. Now imagine how much easier it would be to hold cream, custard or yoghurt. Because they are naturally thicker, they move more slowly, so you are able to control them better.
As you get older, the swallowing muscles in the mouth and throat often become weaker, slower or less efficient. This can be made worse when you’re ill. Certain medical conditions can also affect your swallowing. These changes might make swallowing drinks more difficult so that there is a risk the drink could go down the wrong way. If it gets into the windpipe and even the lungs it can cause you to cough or choke when drinking. This is called aspiration. Sometimes a person might not cough or choke when they have aspirated. This is called ‘silent aspiration’. Aspiration can cause serious chest infections, or even pneumonia.
Thickening your drinks will help prevent this from happening. Because thickened drinks move more slowly in the mouth and throat, you will have more control over them and more time to swallow them safely and easily.
Should I use straws or cups with spouts on when I drink?
You might think that drinking through a straw or a cup with a spout on will be easier. However, this may send the drink further back into the mouth or throat before you have started swallowing. Using straws or spouts when drinking may actually increase the risk of the drink going down the wrong way, causing you to cough or choke. As a general rule, you should not drink through straws or spouts unless your Speech and Language Therapist has told you that this is safe for you.
What are thickened drinks?
These are your normal drinks which have a powder called ‘thickener’ added to them. There are different brands and types of thickener. Thickeners can be either starch based, with the main ingredient being modified starch, or gum based with the main ingredient being xanthan gum. All thickeners work to thicken your drinks, but are prepared using different methods. The type of thickener used most often in Milton Keynes is called ‘Nutilis Clear’. The main ingredient in this is xanthan gum. Nutilis Clear does not add significant calories or nutrients to your drinks. Nutilis Clear is gluten and lactose free.
Where do I get the thickener?
Thickeners are available on prescription from your Doctor like your other medications. If you are in hospital, the nursing staff on the ward will give the thickener to you. If you are at home or in
a care home, your Speech and Language Therapist will ask your Doctor to prescribe the thickener for you.
Which drinks do I need to thicken?
To make sure you are swallowing safely when drinking, you need to thicken all your drinks to the thickness recommended by your Speech and Language Therapist. For example:
• water or water-based drinks e.g. squash / cordial
• hot chocolate
• milk or milky drinks, e.g. Horlicks, Ovaltine
• fizzy drinks
• fruit juice
• fruit smoothies or yoghurt drinks
• alcoholic drinks (if allowed)
• nutritional supplements, e.g. Ensure
Most people need to drink 6-8 glasses or mugs of fluid (around 2 litres) every day to keep well hydrated. You may need more on a hot day.
If you’re eating soups, gravies or sauces which are very runny or watery, you need to thicken these as well. If you’re having milk in your cereals, either thicken the milk to the correct thickness or make sure the milk has been fully absorbed by the cereal before eating. You should avoid eating ice cream, ice lollies, sorbet or jelly. Although they look like solid food, they melt in the mouth very quickly and turn back into liquids, so you may not swallow them safely.
How much thickener do I need in my drinks?
There are four different levels of liquid thickness. Your speech and language therapist will tell you which thickness level you need.
The amount of thickener required for each level of fluid will vary between different types and brands of thickener. Always read the instructions on the tin to establish how many scoops of thickener are needed. Always use the scoop supplied in the tin, as scoops vary between different brands of thickener.
For drinks made with Nutilis Clear the following amount of thickener is needed:
Please use the small green scoop in the tin:
LEVEL 1 FLUIDS – 1 level scoop of Nutilis Clear per 200ml
LEVEL 2 FLUIDS – 2 level scoops of Nutilis Clear per 200ml
LEVEL 3 FLUIDS – 3 level scoops of Nutilis Clear per 200ml
LEVEL 4 FLUIDS – 7 level scoops of Nutilis Clear per 200ml
Some drinks are already naturally thick, for example, thick milkshakes, fruit smoothies, yoghurt drinks, or milky drinks made with full fat milk. You will need to use a little less thickening powder in these drinks than more watery drinks.
What can family; carers and friends do to help?
Ask them to show a positive attitude to thickened drinks at all times to encourage you to drink. Ask them to try your drinks and to read this booklet. You may need to remind them that the reason you’re having thickened drinks is so that you can drink safely without it going down the wrong way. If family, carers or friends are making your drinks for you, make sure they read the following instructions so that they can make your drinks in the right way.
How do I thicken my drinks?
Gum Based Thickeners (such as ‘Nutilis Clear’):
Starch Based Thickeners (such as ‘Thick&Easy’ and ‘Nutilis Powder’):
Starch based thickeners are mixed slightly different to the instructions above. Unlike gum based thickeners, which require the powder to be added first and the liquids to be added second, starch based thickeners can be mixed in any order – it does not matter if you add the liquid or the powder to the cup first. All other stages should be followed as above.
What about swallowing my tablets?
For medication to work properly, you need to take them in the form they are prescribed. Changing how the medication looks on the outside, by crushing, chewing or sucking your tablets or emptying your capsules, will change how they work in the body. However, many people with swallowing problems find it difficult to swallow tablets and capsules. Do not crush, chew or suck your tablets or empty your capsules without asking your Doctor or Pharmacist first. In some cases, doing this may stop the medication from working properly. It could also cause you to have side effects or may be harmful. Speak to your Doctor or Pharmacist about your difficulties swallowing tablets. They may be able to prescribe your tablets in a liquid form instead. If your medications have been prescribed in a liquid form or a dissolvable tablet or sachet, make sure you thicken it to the correct thickness as you would your other drinks.
To do this:
1. Mix the thickener with some water in the usual way to make a drink which is slightly thicker than you would normally have.
2. Dissolve the tablet or sachet first in a small amount of water and then whisk the liquid medication into the drink.
You must also do this if your Doctor or Pharmacist has told you to crush your tablets or empty your capsules. Check with them first that you can add thickener to the medication.
If you have any questions or concerns, please contact your Speech and Language Therapist. The Adult Speech and Language Therapy team is based at Milton Keynes University Hospital NHS Foundation Trust and can be contacted on 01908 725292.