IDDSI Diet Levels & Information

7 – Regular
6 – Soft and Bite Sized
5 – Minced and Moist
4 – Pureed
3 – Liquidised
Transitional Foods

 

Level 7 – Regular

What is a Regular diet? It is a diet which:

  • Normal, everyday foods of various textures that are developmentally and age
  • Any method may be used to eat the foods
  • May be hard and crunchy or naturally soft
  • Sample size not restricted
  • Includes hard, tough, chewy, fibrous, stringy, dry, crispy, crunchy or crumbly bits
  • Includes food that contains pips, seeds, pith inside skin, husks or bones
  • Includes ‘dual consistency’ or ‘mixed consistency’ foods and liquids

 

Level 6 – Soft and Bite-sized

What is a Soft & Bite-sized diet? It is a diet which:

  • Can be eaten with a fork, spoon or chopsticks
  • Can be mashed/brown down with pressure from fork/spoon/chopsticks
  • A knife is not required to cut food, but may be used to help load fork/spoon
  • Chewing is required before swallowing
  • Is soft, tender, moist throughout
  • Has no separate thin liquid
  • Bite-sized pieces as appropriate for size and oral processing skills (Paediatric = 8mm pieces, Adults = 15mm pieces)

Testing Method:

If you are unsure whether your food is the correct consistency for a Soft and Bite-sized Diet, you can test it using the fork pressure test:

  • Pressure from fork held on its side can be used to cut/break this texture
  • Sample size (1.5×1.5cm) squashes and changes shape (not returning to its original shape) when pressure applied with base of fork (firm pressure – thumb nail blanches to white)

 

Level 5 – Minced and Moist

What is a Minced and Moist diet? It is a diet which:

  • Can be eaten with a fork or spoon
  • Can be scooped and shaped on a plate
  • Soft and moist with no separate thin liquid
  • Small lumps visible within food (Paediatric= 2mm lump size, Adult = 4mm lump size)
  • Lumps are easy to squash with tongue

Testing Method:

If you are unsure whether your food is the correct consistency for a Minced & Moist Diet, you can test it using the Fork pressure test:

  • Particles should easily be separated between and come through the prongs of a fork when pressed
  • Particles can be easily mashed with little pressure from a fork

This consistency can also be tested using the fork drip test:

  • The scooped sample sits in a pile or can mound on the fork
  • It does not easily or completely flow or fall through the prongs of a fork

N.B. Lump sizes must be no bigger than:

  • 2mm for children
  • 4mm for adults

Click here for an IDDSI YouTube Video demonstrating how to complete the fork-pressure-test.

 

Level 4 – Pureed

What is a Pureed diet? It is a diet which:

  • Is usually eaten with a spoon (fork is possible)
  • Does not require chewing
  • Can be piped, layered or moulded
  • Has no lumps
  • Is not sticky
  • Liquid must not separate from solid

Testing Method:

If you are unsure whether your food is the correct consistency for a Pureed Diet, you can test it using the spoon tilt test:

Take a spoonful of food and tip it off of the spoon. The food should be:

  • cohesive enough to hold its shape on the spoon
  • the full spoonful must plop off spoon if tilted/turned sideways (sliding off easily with very little left on the spoon)

Take a forkful of food. The food should:

  • Sit in a mound or pile above the fork
  • A small amount may flow through and fork a tail below the fork
  • Does not dollop, flow or drip continuously through the fork prongs

Click here for an IDDSI YouTube Video demonstrating how to complete the spoon-tilt-test.

 

Level 3 – Liquidised

What is a liquidised diet? It is a diet which:

  • Cannot be piped, layered or moulded on a plate
  • Cannot be eaten with a fork because it drips slowly in dollops through the prongs
  • Can be eaten with a spoon
  • No oral processing/chewing required—can be swallowed directly
  • Smooth texture with no ‘bits’ (lumps, fibres, bits of shell or skins, husk, particles of gristle or bone)

Testing Method:

If you are unsure whether your food is the correct consistency for a Liquidised Diet, you can test it using the fork drip test:

  • Scoop up the food with a fork
  • The food should drip slowly or in dollops/strands through the slots of the fork

Click here for an IDDSI YouTube Video demonstrating how to complete the fork-drip-test.

Transitional Foods

What are Transitional Foods? They are foods which:

  • start as one texture (e.g. firm solid) and change into another texture specifically when moisture (e.g. water or saliva) is applied, or when a change in temperature occurs (e.g. heating)

Testing Method:

If you are unsure whether your food is a transitional food, you can test it using the fork pressure test:

  • After moisture or temperature has been applied, the sample can be easily deformed and does not recover its shape when force is lifted

Click here for an IDDSI YouTube Video demonstrating how to complete the fork-pressure-test.

 

The International Dysphagia Diet Standardisation Initiative 2016 – http://iddsi.org/framework/.
Attribution is NOT PERMITTED for derivative works incorporating any alterations to the IDDSI Framework that extend beyond language translation. Supplementary Notice: Modification of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such errors have previously been associated with adverse events including choking and death.