Free Water Protocol

By Jennie Shafer / a couple of years ago

Free Water Protocol


The Fraiser Free Water Protocol is a program that allows select patients who are NPO or on thickened liquids, to have unrestricted and unthickened water between meals and 30 minutes after meals. Oral hygiene is of the utmost importance when following this protocol and teeth/mouth must be washed prior to having water, as well as utilizing good body posture and any prescribed compensatory techniques.

Research indicates, water that enters the lungs may be absorbed into the bloodstream and there is minimal likelihood for developing pneumonia as long as exposure to the bacteria is limited. This is why good oral hygiene is important prior to having water if there is a risk for aspiration. It has also been noted that allowing free water increases quality of life, decreases dehydration and keeps patients more compliant with thickened liquid protocol.


Studies have only been done with adults and it is up to the discretion of the family, the feeding therapist and the child’s doctor to decide what is best.


The Free Water Protocol does not allow participants to take medications with water and they must continue to drink thickened liquids during meal or snack time.


Dysphagia alone, does not cause pneumonia. There are multiple factors that increase a patient’s chances of developing pneumonia, including, but not limited to:

  • Dependence for feeding &/or oral care
  • Decayed teeth
  • Tube feeding
  • Multiple diagnoses
  • Multiple medications
  • Decreased activity level
  • Smoking



About the author

Jennie Shafer

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