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Aspiration and pneumonia are common in people with eating, drinking and swallowing difficulties. Thickened liquids are often used as a first-line measure by speech-language pathologists and other health and social care professionals to reduce aspiration and pneumonia in people with eating, drinking and swallowing difficulties. This approach, and the relative lack of evidence of benefit, has come under increased criticism in recent years. This aim of this review is to examine alternatives—or complementary approaches—that might be considered by SLPs and other professionals treating people with eating, drinking and swallowing difficulties. We examined the current research evidence and will discuss medical factors, bolus modification approaches, rehabilitation approaches, hygiene and residue reduction interventions, physical and postural interventions, common sense strategies, and other issues to consider when using thickened liquids. We conclude that there are many options available to health and social care professionals who are supporting people with eating, drinking and swallowing difficulties, some of which have a less, equal or more supportive evidence base than thickened liquids. A broad multidisciplinary and multifactorial approach is beneficial, and more acceptable to, people with eating, drinking and swallowing difficulties. [ABSTRACT FROM AUTHOR]