What is a Level 6 Diet?
An example of a Level 6 diet is often prescribed by a healthcare professional, such as a Speech-Language Pathologist or Dietitian, for individuals experiencing mild chewing or swallowing difficulties (dysphagia). The International Dysphagia Diet Standardisation Initiative (IDDSI) defines this diet as "Soft & Bite-Sized," highlighting the two key requirements: the food must be soft and tender, and all pieces must be cut to a specific size. This reduces the risk of choking and makes eating a safer, more manageable experience.
Key Characteristics of a Level 6 Diet
The IDDSI framework provides clear, global standards to ensure consistency and safety across all healthcare settings. The primary characteristics of a Level 6 diet include:
- Soft and Tender: Food should break apart easily with the pressure of a fork or spoon.
- Bite-Sized Pieces: For adults, food pieces must be no larger than 1.5 cm x 1.5 cm (about the size of a thumbnail or the width of a standard dinner fork). For children, the size is smaller, at 8 mm.
- Moist Texture: Foods should be moist throughout, often requiring thick sauces, gravies, or custard to prevent them from becoming dry or crumbly.
- No Separate Thin Liquid: The food should not have thin, watery liquid that separates from the solid components, as this creates a mixed consistency that can be dangerous.
- Moderate Chewing Required: Unlike pureed diets, this level requires moderate chewing ability.
Example Meal Ideas for a Level 6 Diet
Following a Level 6 diet doesn't mean sacrificing variety or enjoyment. By modifying preparation methods, many everyday meals can be made suitable. Here are some examples for each mealtime:
Breakfast Ideas
- Porridge or instant oat cereal, cooked until soft and moist.
- Scrambled eggs, cooked until creamy and moist.
- Weetabix soaked in milk, with excess liquid drained.
- Mashed or thinly sliced ripe banana or soft tinned fruit like peaches.
Lunch Ideas
- Tuna or salmon mashed with mayonnaise, served on soft bread with crusts removed (cut into bite-sized pieces).
- Macaroni and cheese, ensuring the pasta is well-cooked and the pieces are cut to size.
- Jacket potato filling (no skin) with a moist, soft topping like cottage cheese or egg mayonnaise.
Dinner Ideas
- Shepherd's or cottage pie with a tender meat filling and soft mashed potato topping.
- Tender chicken or beef casserole, slow-cooked until meat is very tender and cut into bite-sized pieces.
- Flaked fish in a creamy white or parsley sauce.
- Well-cooked pasta in a thick bolognese sauce.
Dessert and Snack Ideas
- Smooth yoghurt or fromage frais.
- Milk puddings like rice pudding or semolina.
- Crème caramel or smooth mousse.
- Soft sponge cake with custard.
- Stewed apple (without skin or chunks).
Preparing Food for a Level 6 Diet
Preparation is crucial for a Level 6 diet to ensure food is safe. Follow these tips:
- Cooking: Cook all food until very soft and tender. Slow-cooking meats and boiling vegetables until soft are effective methods.
- Cutting: Before serving, cut all solid food items into pieces no larger than 1.5 cm x 1.5 cm for adults. A fork or spoon can often be used to break the food down further.
- Moisturising: Add thick gravies, sauces, or custard to prevent food from becoming dry. This also helps bind smaller pieces together.
- Testing: Always perform a fork or spoon pressure test before serving. The food should squash easily and not return to its original shape.
- Reheating: Check the texture again after reheating, as it can change the consistency of food.
Foods to Avoid on a Level 6 Diet
Avoiding certain textures is just as important as including safe foods. The following should be completely avoided:
- Hard, tough, or chewy foods: Steak, bacon, tough raw vegetables like carrots, and crusty bread.
- Crumbly or flaky foods: Pastries, crumble toppings, dry biscuits, and toast crusts.
- Fibrous or stringy foods: Pineapple, celery, runner beans, and asparagus stalks.
- Sticky foods: Peanut butter, sticky mashed potato, or taffy.
- Mixed consistencies: Foods with a combination of thin liquid and solid chunks, like minestrone soup or cereals that don't fully soften.
- Foods with husks, skins, or seeds: Corn kernels, peas, grapes, and fruit skins.
- Crunchy textures: Crisps, nuts, popcorn, and some fried coatings.
Comparing IDDSI Levels: Minced & Moist vs. Soft & Bite-Sized
| Feature | Level 5: Minced & Moist | Level 6: Soft & Bite-Sized |
|---|---|---|
| Food Texture | Lumps no larger than 4mm, requiring some tongue pressure to squash | Bite-sized pieces no larger than 1.5cm x 1.5cm, mashable with a fork |
| Chewing Required | Minimal chewing needed, primarily managed by the tongue | Moderate chewing is required before swallowing |
| Moisture Level | Moist throughout with no separate thin liquid | Moist throughout with no separate thin liquid |
| Appearance | Lumps are uniform and suspended in a thick, smooth sauce/gravy | Clearly defined soft, tender pieces |
| Target Population | Individuals with very weak chewing ability or poor tongue control | Individuals who can chew soft, bite-sized pieces safely |
Conclusion
Following a Level 6 diet is a practical and safe approach for individuals with mild dysphagia who can manage soft, bite-sized foods. The guidelines from the IDDSI provide clear instructions on what to eat, what to avoid, and how to prepare meals to ensure safety. By focusing on tender, moist, and appropriately sized foods, those on a Level 6 diet can maintain a nutritious and enjoyable diet with minimal choking risk. Consulting a Speech-Language Pathologist or Dietitian is essential for personalized advice and to ensure the diet is suitable for individual needs.
An excellent authoritative source on dysphagia diets and the IDDSI framework is the official International Dysphagia Diet Standardisation Initiative website.
