Thick-it? Let’s Talk About Consistency.

Dear Readers,

Sometimes while working in the medical setting, (especially with high turn over rate, and at times non-compliance) remaining on the same page regarding patients’ diets can be a challenge.

This post is to provide a resource and an open door to discuss diet textures with staff members. Let’s begin here.

Diet Texture In-service

Dysphagia (difficulty swallowing)

Aspiration (food/liquid enters the airway to the lungs)

Re: National Dysphagia Diet Guidelines


Solid Levels

Dysphagia Level 1: Pureed

Pudding-like smooth/even consistency, require very little chewing

Examples: Pureed meats, smooth pudding custards, yogurt (no fruit), pureed bread/rice, mashed potatoes, pureed vegetables without lumps, tomato sauce without seeds




Dysphagia Level 2: Mechanical Soft/Chopped

Moist, semi- solid foods (may have lumps), require some chewing

Examples: Moistened ground meat, soft and drained canned fruits/vegetables without seeds, soft fruit pies, custards, well cooked pasta noodles in sauce, moist cakes with icing, scrambled eggs


Mech soft



Dysphagia Level 3: Advanced Mechanical Soft

Closest to regular consistency, requires chewing

Examples: Tender or ground meats/poultry, well-moistened breads/muffins, canned and cooked fruits, peeled fresh fruits (soft berries, kiwis, cantaloupe), rice with gravy, tender fried potatoes



Regular Consistency




Liquid Levels

Pudding Thick

Does not flow off of spoon (should be eaten from the spoon).

pudding spoon


Honey Thick

Slowly drips off of end of spoon

honey run


Nectar Thick

Runs off of spoon but leaves behind coating/residue  (soup-like consistency)

nectar run


Regular Thin Liquids (most difficult to swallow)

Runs off of spoon with no residue left behind

thin run


  • Thickening liquids allows the liquid to travel more slowly so the muscles have more time to react in order to protect the airway.
  • * Do not give a person with liquid restrictions anything that melts into a thin liquid (i.e. ice, ice cream, etc.)
  • *Be cautious of foods that contain thin liquid (watermelon, etc.)
  • Make sure fruits and vegetables are drained.


Overt s/s of Aspiration

Coughing/choking when eating or drinking

Throat clearing following swallow of food/liquid

Gurgly, wet voicing following swallow of food/liquid


Ways to Prevent Aspiration

When feeding a person with dysphagia:

Position patient to 90 degrees upright positioning prior to feeding

Administer small bites and sips

Alternate liquids and solids

Use a slow rate when feeding, allowing the patient to completely swallow food

Check for pocketed food between gums and cheeks


I hope this is useful!

Best regards,

Brittany Fontenot, M.A., CF-SLP


For God did not send His Son into the world to condemn the world, but to save the world.

John 3:17 

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