Understanding the IDDSI Level 6 Diet
The International Dysphagia Diet Standardisation Initiative (IDDSI) created a global framework to classify food and fluid textures for individuals with swallowing difficulties, or dysphagia. The Level 6, known as "Soft & Bite-sized," is designed for people who can chew but may not be able to bite off pieces of food safely. Foods at this level must be soft, tender, and moist, cut into manageable pieces no larger than 1.5cm x 1.5cm for adults. This reduces the risk of choking while still requiring some chewing before swallowing.
Characteristics of Level 6 foods:
- Soft and Tender: Foods must be soft enough to be easily mashed or broken down with the side of a fork.
- Moist: They should be served with a thick sauce or gravy to prevent dryness, and there should be no thin liquid separating from the solid food.
- Bite-sized: For adults, pieces must be no larger than 1.5 cm by 1.5 cm.
- No Hard or Tough Bits: All hard, tough, fibrous, stringy, or crispy parts must be removed.
Why Mushy Peas are a Perfect Fit for Level 6
Mushy peas, by their very nature, are designed to be soft. When cooked correctly, they collapse easily and can be mashed to the appropriate consistency. Unlike whole peas, which have a skin that can be tough or fibrous, pre-prepared mushy peas or correctly prepared marrowfat peas have a texture that can be easily modified for safe consumption. This makes them an ideal choice for adding variety and nutrition to a Level 6 menu.
How to prepare mushy peas for a Level 6 diet
Whether you use dried or tinned peas, the modification process is key to ensuring safety. The goal is to achieve a consistent, moist texture without any tough skins or separate liquid.
Preparing from scratch (dried peas):
- Soak dried marrowfat peas overnight with a pinch of bicarbonate of soda to help soften them.
- Rinse the soaked peas thoroughly and simmer them in fresh water until they are tender and have started to break down.
- Use a potato masher to mash the peas to a smooth, uniform texture, ensuring no skins remain. If using a blender, avoid over-processing which can make them gluey.
- Strain the mashed peas through a sieve to remove any remaining skins or fibrous material, as recommended for pulses by some guidelines.
- Add a knob of butter or a spoonful of cream to enhance moisture and flavour, ensuring the final product is cohesive and not dry.
Preparing from tinned mushy peas:
- Drain the tinned peas well to remove any thin liquid.
- Tip them into a saucepan and gently heat, stirring constantly.
- Use a potato masher to further mash the peas until they reach a uniform, soft consistency.
- Add a small amount of thick sauce, like a cheese sauce, or a bit of butter to improve the moisture content and bind the mixture.
IDDSI Texture Framework Comparison
| Food Aspect | IDDSI Level 6 (Soft & Bite-sized) | IDDSI Level 5 (Minced & Moist) | IDDSI Level 4 (Puréed) |
|---|---|---|---|
| Particle Size (Adult) | ≤ 1.5cm | ≤ 4mm | No lumps |
| Chewing Required? | Yes, moderate chewing | Yes, but easy to mash with tongue | No |
| Moisture | Moist throughout, no separate thin liquid | Moist, but cohesive | Liquid must not separate from solid |
| Fork/Spoon Test | Can be mashed with a fork | Cohesive on a fork | Holds shape on a plate |
| Example (Peas) | Well-mashed mushy peas with skins removed | Very finely minced peas in a thick, binding sauce | Smooth, sieved pea purée |
Potential Risks and How to Avoid Them
While mushy peas can be a great option, certain risks must be managed. The main hazards are tough skins, fibrous material, and excess liquid, which can increase the risk of aspiration. Overcooking and mashing can cause the peas to become watery, so it is crucial to drain and add a thickener if necessary.
To ensure safety:
- Remove Skins: If preparing from dried peas, sieving after mashing is recommended to catch any remaining skins.
- Control Liquid: Always drain canned peas and use a thick, binding ingredient (like butter or sauce) rather than water to ensure a moist, cohesive final product.
- Test Texture: Use the IDDSI fork pressure test to ensure the peas are soft enough to be mashed easily. The food should not spring back to its original shape.
Adding Flavour and Variety to Mushy Peas
Texture modified diets can sometimes lack flavour. Fortunately, mushy peas are a versatile base for adding extra taste and nutrients.
Ideas for enhancing flavour:
- Fresh Herbs: Stir in finely chopped mint or parsley for a classic, fresh flavour.
- Spices: A small pinch of ground white pepper or a sprinkle of nutmeg can add depth without affecting texture.
- Healthy Fats: Mix in some avocado or olive oil for a creamy texture and added nourishment.
- Dairy: A swirl of cream cheese, yogurt, or a rich cheese sauce can make the dish more flavourful and calorie-dense.
- Aromatics: Cook some finely diced onion or leek until very soft and incorporate them for a subtle flavour base.
Conclusion
Yes, a Level 6 diet can have mushy peas, provided they are prepared with careful attention to the correct texture and consistency. By properly cooking, mashing, and, if necessary, sieving to remove tough skins, mushy peas can be a safe, delicious, and nutritious addition to a soft and bite-sized diet. Ensuring the final dish is moist and cohesive is paramount to preventing choking risks. Always follow the IDDSI guidelines and consult with a healthcare professional or speech and language therapist for personalised dietary advice. For more detailed information on IDDSI levels, visit the official framework guidelines at the International Dysphagia Diet Standardisation Initiative website.
