Many people with dysphagia are told to drink thickened liquids to help reduce aspiration risk. The Frazier Free Water Protocol offers a different approach by allowing carefully managed access to thin water under specific conditions. For many, it can improve hydration and quality of life.
What Is the Frazier Free Water Protocol?
The Frazier Free Water Protocol is a dysphagia management strategy that allows individuals on thickened liquids to drink thin water between meals under strict guidelines, typically after thorough oral care.
The key components of the protocol are:
- Water only (while juice, coffee, tea, etc. are also thin liquids, plain water is the only one permitted)
- Given between meals, not with food
- Complete oral hygiene before access
- Supervision and clinical approval required
These few rules are pretty easy to follow with a little training from your care team.
Why Was it Developed?
One of the main tradeoffs to thickened liquids is the risk for dehydration across people that do not enjoy them. They feel weird in the mouth, they don’t have as much ability to replace the water we lose throughout the day, and the flavors of the liquid thickened may not be the same. This leads to people drinking less or refusing to drink completely; sometimes they start drinking liquids secretly from sinks and other sources, which lead to serious lung infections.
To make sure an worse problem doesn’t complicate their clients health, a team of clinicians worked with pulmonologists (lung specialists) to discover that the lungs are actually pretty good at managing clean, pH-neutral liquids. The true culprit for pneumonia was the bacteria that was traveling from their mouth along with the liquids. Therefore, by thoroughly cleaning the mouth, thin liquids could be offered to improve not only hydration, but quality of life in those on thickened liquids.
Who Might Be a Candidate?
While this is an exciting option to have available, it does not get recommended to every client. For a formal recommendation, an evaluation by a speech-language pathologist (SLP) is a must. Your clinician will look at
- Medical stability
- Level of cognitive awareness
- Ability to follow instructions for good oral hygiene
of the client (or the caregiver as needed) before making a decision. As those aspects are not set in stone, it is possible that if the Frazier Free Water Protocol is not recommended initially, it could become an option later. The protocol does not reduce aspiration risk, but when all of these conditions are fully met, risk of aspiration pneumonia or dehydration are managed.
How This Affects Meals
As I mentioned above, the Frazier Free Water Protocol is not to be used during meals. But that doesn’t mean that using this tool doesn’t assist with safe swallowing at mealtime! When a person with dysphagia has better hydration, their saliva production improves, which not only help lubricate things in the mouth, saliva provides a helping hand with digestion further down the line. Also, the secretions that happen in the throat and along the path to the stomach will thin out, making it easier to clear residues after the swallow. Dry mouth can lead to a sensitive mouth, so the water can help hydrate the membranes to avoid pain from chewing and swallowing and improve awareness of the bite in the mouth. And finally, hydration can help with alertness and appetite, which make it safer for people who are getting assistance with feeding themselves.
If you are also looking for recipes that help explain how to adapt into a texture that best fits where you are right now in your dysphagia journey, you can start with my introduction to dysphagia recipes. Confused about how to support your loved one during this time? Learn about eating in social situations when swallowing is hard.
Every recipe here is designed for texture sensitive eaters: from dysphagia to dental issues to picky eaters. Get recipe roundups and practical tips by joining the mailing list.
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