The “Water Protocol” (often called the Frazier Free Water Protocol) is an approach in dysphagia management that permits patients who are on thickened liquids or non-oral diets to have access to thin water under specific conditions. The rationale is that water, if aspirated, is relatively benign to the lungs in small amounts (unlike other liquids that may cause pneumonia due to bacteria or acidity), and allowing water can improve patient hydration and quality of life.
Typically, a water protocol includes strict guidelines: water is allowed only between meals (at least 30 minutes after eating) and not with food or medication; thorough oral care must be performed to minimize oral bacteria before water intake; and the patient should be supervised and use recommended swallowing strategies. Any patient with a known aspiration risk may participate unless contraindicated (e.g., medically fragile or incapable of attempting safe swallows even with strategies). By following these safeguards, studies have shown patients can often enjoy water without a higher incidence of aspiration pneumonia.
In practice, SLPs implement the water protocol in hospitals or rehab settings as part of dysphagia therapy – they educate the healthcare team and patient on the rules, monitor for coughing or adverse signs, and thus provide a measure of safe oral intake to individuals who would otherwise be strictly on thickened liquids or NPO (nothing by mouth). This protocol represents a person-centered compromise in dysphagia management, balancing risk and benefit to improve patient comfort.
Panther, K. (2005). The Frazier Free Water Protocol. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 14(1), 4–9. Link
Karagiannis, M. J. P., Chivers, L., & Karagiannis, T. C. (2011). Effects of oral intake of water in patients with oropharyngeal dysphagia.BMC Geriatrics, 11, 9. Link
