Understanding the IDDSI Level 6 Diet
The International Dysphagia Diet Standardisation Initiative (IDDSI) created a global framework to provide consistent terminology and standards for texture-modified foods and thickened liquids. IDDSI Level 6, known as "Soft & Bite-sized," is designed for individuals who have mild swallowing difficulties (dysphagia) or limited chewing ability. Key characteristics of this diet level include:
- Soft, tender, and moist foods: The food should be soft enough to be broken down with a fork and not regain its original shape.
- Bite-sized pieces: Food must be cut into small pieces, typically no larger than 1.5cm x 1.5cm (about the width of a standard fork) for adults.
- No thin liquids: No separate, thin liquid should run or drip from the food.
- Requires chewing: Some chewing is necessary, but a knife is not required to cut the food.
Why Regular Bread Is a Hazard
For most people on a Level 6 diet, standard bread poses a significant safety risk. It does not meet the necessary texture and moisture requirements. The primary dangers include:
- Dry and crumbly texture: Regular bread, toast, and crackers can be dry and separate into small, sharp crumbs in the mouth. These small particles can be difficult to control and may be accidentally inhaled into the lungs, leading to a chest infection or aspiration pneumonia.
- Chewy or gummy consistency: Many types of bread, especially freshly baked or crusty varieties, can form a sticky, gummy mass when chewed. This bolus can be challenging to swallow and may become lodged in the throat, creating a choking hazard.
- Mixed consistency: Dry bread combined with a thin spread like jam or butter can create an unsafe mixed consistency. The different textures separate in the mouth, and the thin liquid can travel down the throat quickly, while the solid food lingers, increasing the risk of aspiration.
Safe Methods for Including Bread Products
While regular bread is usually off-limits, certain modified bread products or preparation methods can be safe for Level 6. It is critical to follow a healthcare professional's, such as a Speech and Language Therapist's (SLT), instructions.
Preparing Safe Bread Options
- Pre-soaked bread: Plain white or wholemeal bread can be finely chopped and thoroughly pre-soaked in a liquid like a thick soup, sauce, or milk until it forms a soft, cohesive mass. Excess liquid must be drained to maintain the appropriate texture.
- Soft sandwiches with moist fillings: Use soft, plain white or wholemeal bread with the crusts removed. The filling must be moist and not contain hard bits, seeds, or nuts. Good options include egg mayonnaise, tuna mayonnaise, or creamy spreads. The sandwiches must then be cut into bite-sized pieces.
- Pureed toast: One method for preparing toast is to lightly toast plain, seedless bread (crusts removed), break it into pieces, and blend it in a liquidizer with plenty of melted butter and warmed jam to create a Level 6 consistency.
- Pre-gelled bread products: Some commercial products are specifically formulated to meet IDDSI standards. These are designed to be very moist and to hold their form without being sticky.
Safe Starch Alternatives for a Level 6 Diet
Instead of attempting to modify bread, many other starches are naturally easier to prepare for a Level 6 diet. These include:
- Pasta: Well-cooked pasta, such as macaroni, ravioli, or spaghetti, cut into bite-sized pieces and served in a thick, smooth sauce.
- Rice: Cooked until very soft and served in a thick, non-pouring sauce that binds the grains together, such as a creamy risotto or rice pudding.
- Potato: Boiled or roasted potatoes, cooked until very soft, mashed with milk and butter, or cut into bite-sized pieces. Skins should be removed.
- Cereal: Porridge or other fine-grain instant cereals like Ready Brek, fully softened with milk. Excess milk should be drained before serving.
- Cakes and Desserts: Plain, soft sponge cakes can be moistened with cream or custard. Soft biscuits can be dunked in tea until soft. Avoid dry or crumbly cakes.
Table: Bread and Starch Options for a Level 6 Diet
| Food Item | Condition for Level 6 Diet | Why Regular Preparation is Unsafe |
|---|---|---|
| Regular Bread | Finely chopped, soaked in sauce/milk, excess liquid drained. | Dry, crumbly, and forms a sticky mass. |
| Soft Sandwiches | Use soft bread (crusts removed), moist fillings (e.g., egg salad), cut into 1.5cm pieces. | Dry bread and crusts are choking hazards. Fillings can have mixed consistencies. |
| Pureed Toast | Toast blended with liquid (melted butter, jam) into a consistent, moistened puree. | Plain toast is hard, dry, and crumbly. |
| Well-cooked Pasta | Boiled until very soft, cut into 1.5cm pieces, and served in a thick sauce. | Under-cooked pasta can be hard or chewy. |
| Soft-cooked Rice | Cooked until very soft and bound in a thick sauce; not sticky or separated. | Dry, grainy rice is hard to swallow. Sticky rice can become a choking hazard. |
| Mashed Potatoes | Cooked until very soft, skins removed, mashed thoroughly with milk and butter. | Hard lumps or potato skin are difficult to chew and swallow. |
Always Consult a Professional
While this guide provides general information, the decision to include bread or any food item in a Level 6 diet should only be made in consultation with a qualified healthcare professional. A speech and language therapist can properly assess an individual's chewing and swallowing abilities and provide personalized advice. Trying to modify your diet without professional guidance could lead to serious health risks, including choking and aspiration.
Conclusion
In summary, a Level 6 diet can have bread, but only if it is significantly modified to meet strict texture and moisture standards. Regular, dry, or crusty bread is unsafe and should be avoided. Safe modifications include finely chopped and pre-soaked bread, soft sandwiches with moist fillings, or pureed toast. Numerous other safe starchy alternatives exist, such as well-cooked pasta, soft rice dishes, and mashed potatoes. Always work with a healthcare professional to ensure food is prepared safely and is appropriate for the individual's specific needs.
For more information on IDDSI standards and testing methods, visit the official IDDSI website.
