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Level 4 thickened fluids (extremely thick)

Your Speech and Language Therapist has assessed your swallow function and has recommended that you thicken your drinks to make your swallow safer. You have been prescribed Nutricia Nutilis Clear to thicken your drinks to level 4 consistency.

This will make a consistency which:

  • Usually eaten with a spoon
  • Cannot be drunk from a cup
  • Cannot be sucked through a straw

How does it help?

The consistency (thickness) of your drinks will be adapted to help with your ability to swallow. It slows down the rate at which the drink travels down your throat towards your stomach. It can reduce the risk of fluids going down the wrong way into your windpipe. It is important to thicken all your drinks as advised to reduce the risk of this happening.

What is Nutricia Nutilis Clear?

It is a Xanthan gum based powder which is a white, oderless, tasteless powder used to thicken fluids. It does not alter the smell or taste of drinks but it does alter the consistency of your drinks

Instructions of how to prepare Level 4 consistency drinks using Nutricia Nutilis Clear:

  • Add seven scoops per 200ml of liquid (tea, coffee, water, juice, etc.)
  • Put powder in first to a dry cup/glass/beaker using the measuring scoop.
  • Then pour the liquid over the powder
  • Stir briskly – the drink will thicken quickly so please start stirring with a spoon immediately until the powder is completely dissolved.
  • Leave to stand for a few minutes if needed for the drink to reach the desired thickness. Powder cannot be added once a drink has been thickened
  • Enjoy your drink.

ALL fluids must be thickened to this consistency, e.g. gravy, sauces, soup, hot and cold drinks including water, carbonated and alcoholic drinks.

If you require any further information about modified thickened fluids, please discuss with your Speech and Language Therapist.

Top tips

  • Establish how much fluid your cup/beaker/glass holds before you make the drink as this will affect the number of scoops of powder you need.
  • Drinks that have more than one part (e.g. tea and milk, cordial and water) should be prepared in a separate cup and then poured onto the powder.
  • Let drinks stand for a few minutes to allow time to reach the correct thickness; don’t be tempted to add more powder.
  • Prepare a jug of your drink and keep it in the fridge to save you having to prepare a number of drinks.
  • It is important to keep your teeth and mouth clean as swallowing saliva with bacteria can lead to chest infections. Aim to brush your teeth, tongue and gums at least twice a day with a low foaming toothpaste.
  • Thickener may affect how your medication works. Check with your pharmacist or doctor if you have any concerns

If you need thickener to put in your drinks after you are discharged from hospital this will be arranged through your GP.

Please contact the Speech and Language Therapy department if you have any questions: 0151 529 5593

Visit or call 0151 298 2999 for advice and information for people with neurological conditions and their carers

  • Last Updated:
    01 August 2018
  • Review Date:
    01 August 2026
  • Author:
    Lucy Roebuck
  • Summary:

    Your Speech and Language Therapist has assessed your swallow function and has recommended that you thicken your drinks to make your swallow safer.

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