by Isabel Isa, Samantha Yeo, Jeanette Lee

“I’ve always wondered what it’s like to be on thickened fluids.”

“Really? Me too!”

“You mean like… one cup only, or more than that?”


What began as a random conversation between two colleagues after work led to a group of Speech Therapists at Khoo Teck Puat Hospital to undertake the newly coined Thickened Fluids Challenge in March.


For 48 hours, the group of seven colleagues agreed to thicken all their fluids. ALL FLUIDS. Given that these were the exact recommendations we prescribe to our patients on a daily basis, we assumed (wrongly) that it wouldn’t be a difficult one to follow.

It wasn’t long before the common complaints of thirst and dissatisfaction emerged. Coping strategies were frantically employed to stay compliant. Some of us actively avoided drinking just to bypass the thickener! Others bought porridge for lunch and drank more thickened fluids in a valiant attempt to quench their (seemingly never-ending) thirst – only to find themselves feeling uncomfortably bloated. Flavoured drinks, although slightly more bearable, did little to mask the viscosity of thickened water.

Honey-thick fluids – Mee Rebus

New problems arose after we each headed home from work. Logistical issues were the most prominent – some of us forgot to bring thickener altogether whilst others underestimated the amount needed for an evening’s worth of fluids. Some misplaced their measuring scoop! One participant opted to withdraw from the challenge after suspecting an onset of urinary tract infection. TMI ALERT: Unusual bowel movements were also a common report coming from a number of participants. Some family members reacted to the challenge with curiosity and bewilderment. And thus, the second day brought us much relief knowing that we had been ‘upgraded’ to nectar-thick fluids.


Conversations after the challenge brought about a deeper sense of understanding for our patients and their experiences with thickened fluids. We found ourselves less judgmental towards patients who genuinely forgot and accidentally took a sip of thin fluids out of habit. We also became more acutely aware of the practical barriers that our patients and their caregivers face, especially those who are still out and about in the community. It would not be uncommon for one to forget to bring thickener, or have insufficient thickener, but only realizing after they’ve reached the coffee shop. Given the myriad of cup sizes out in the community, would it mean that our patients would need to carry their bottle of thickener and a measuring cup for every trip outside? Patients on thickened fluids may also face varying forms of social pressure in the community, from curious stares, to the same questions being asked of them by different people.


One thing that helped us complete this challenge was being able to do it as a group. The Whatsapp group and lunching together gave us many opportunities to remind each other to “comply” with thickened fluids and support each other through the challenge. Creative ideas to increase our fluid intake, or to make our drinks and meals more palatable, were rampant on the chatgroup. Photos of our meals or fluids for the day also provided a source of puns and jokes which made the process more enjoyable. Above all else, this Thickened Fluids Challenge served its purpose of broadening our minds and forcing us to truly consider the implications of prescribing thickened fluids to a patient. Curious about trying this for yourself? Get a circle of colleagues together and document the process. Then, let us know how it went for you!

Isabel: Works at Khoo Teck Puat Hospitals. She enjoys circus arts in her free time.






Samantha: Works at Ng Teng Fong Hospital, met some lovely people while seconded at Khoo Teck Puat Hospital, and hence the birth of this article.






Jeanette: Works at Khoo Teck Puat Hospital. Enjoys sports and putting Ikea furniture together.