Clinicians who manage patients with dysphagia face especially difficult challenges when working with patients who exhibit the aspiration of dietary fluids. These patients must be kept safe from aspiration while still meeting requirements for hydration intake. Although it is possible to hydrate the body through non-oral routes such as nasogastric tubes, IV infusion, total parenteral nutrition, etc., these methods can pose serious health consequences. Consequently, a primary goal of dysphagia management is to meet nutrition and hydration needs by mouth while reducing the risks of aspiration.

Three primary methods are used to accomplish this end: thickened liquids, swallowing compensations/maneuvers, and swallowing therapy. Logemann (1998) argued that diet modifications including thickened liquids should be used only when other methods have failed. Although that scenario may represent the ideal, McCullough et al.(2004) reported that the use of thickened liquids has become one of the most common recommendations made by clinicians. The researchers concluded that this method is used because it is easy to implement. In a survey of long-term care facilities, Castellanos et al.(2004) reported that a mean of 8.3% of residents were receiving thickened liquids. In one facility, the figure was a strikingly high mean of 28%. Although the method is commonly used, the evidence base supporting thickened liquids remains limited (Robbins, et al., 2002; Steele, 2005) and their use can present challenges in dysphagia management.