Easy to Chew Level 6 Explained: A Comprehensive Guide

October 29, 2025 •

5 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a global framework used to classify food textures, easy to chew Level 6, or Soft & Bite-Sized, is designed for individuals who can chew but have difficulty biting off pieces of food. This food texture category requires minimal effort to chew and swallow, significantly reducing the risk of choking for those with chewing problems. Understanding the specific criteria is crucial for safely preparing meals that meet this important dietary standard.

Quick Summary

IDDSI Level 6, also known as Soft & Bite-Sized, is a food texture for people with chewing issues but some chewing ability. Food must be tender, moist, and in pieces no larger than 1.5cm for adults, passing the fork pressure test to ensure safety and prevent choking.

Key Points

Particle Size Restriction: For adults on an easy to chew Level 6 diet, all food pieces must be cut or prepared to be no larger than 1.5 cm x 1.5 cm to prevent choking.
Fork Pressure Test: The food must be soft enough to be easily mashed and broken apart using the side of a fork, with the pressure from a thumb turning the nail white.
Soft and Moist Throughout: Level 6 food must be tender, soft, and moist, with no hard, chewy, or crunchy parts, requiring a sauce or gravy to bind and moisten it.
Chewing is Required: This diet is for individuals who have some chewing ability but cannot safely bite off or manage larger pieces of regular food.
Avoid Mixed Consistencies: Foods should not contain thin, watery liquids separate from solids, as this increases the risk of aspiration.
Examples Include: Tender stews, shepherd's pie, well-cooked pasta in thick sauce, and soft fruits like bananas or tinned peaches.
Purpose: It is used for people with chewing issues due to dental problems, ill-fitting dentures, or neurological conditions.

The Core Principles of Easy to Chew Level 6

Easy to chew Level 6 is formally called "Soft & Bite-Sized" within the IDDSI framework, an international standard for texture-modified foods and thickened liquids for people with dysphagia (swallowing difficulties). This diet is a critical step for many individuals transitioning from softer diets to a regular texture, or for those with persistent chewing challenges, such as people with dental problems, missing teeth, or dentures. Its defining characteristics focus on particle size, softness, and moisture to ensure food is safe to chew and swallow.

Key Characteristics of Level 6 Food

To be considered a Level 6 food for adults, several specific criteria must be met:

Particle Size: Food pieces must be no larger than 1.5 cm by 1.5 cm, which is roughly the width of a standard dinner fork's tines. For children, the safe size is significantly smaller, at 8mm. This strict size limitation minimizes the risk of large food particles causing a choking hazard.
Soft and Tender Texture: The food must be tender and moist throughout, with no hard, tough, or chewy pieces. This softness is easy to test using simple kitchen utensils, as the food should break apart easily under fork pressure.
Cohesive but not Sticky: Level 6 foods must hold together without being sticky or adhesive. The food should not be sticky or cohesive enough to leave a residue on the mouth or palate, which could increase the risk of choking.
No Thin Liquids: Foods should not contain separate, thin liquid that can cause mixed consistencies, such as soup with solid chunks. Any sauces or gravies must be thickened to prevent this separation and reduce aspiration risk.

How to Test Foods for Level 6 Compliance

Before serving, all food intended for a Level 6 diet should be tested using the following IDDSI methods:

Fork Pressure Test: Press down on a piece of food with the side of a fork. The piece should squash and break apart easily. The pressure should be enough to turn your thumbnail white. After removing the fork, the food should remain squashed and not return to its original shape.
Fork or Spoon Mash Test: Try to mash a piece of food with the tines of a fork or the side of a spoon. It should mash easily with minimal effort. This confirms the softness of the food.
Appearance Check: Visually inspect the prepared meal to ensure no food particles exceed the 1.5 cm x 1.5 cm size limit for adults. If a standard fork is not available, the width of an adult's thumbnail can be used as a size guide.

Example Meal Ideas for a Level 6 Diet

Preparing a nutritious and enjoyable Level 6 diet involves modifying textures while retaining flavor. Here are some examples for various meal times:

Breakfast: Porridge or fortified hot cereal with milk, scrambled eggs, or smooth, full-fat yogurt with finely chopped or mashed ripe fruit like banana or peaches.
Lunch: Soft sandwiches with crusts removed and fillings like egg or tuna mayonnaise, cut into small bite-sized pieces. Well-cooked pasta in a thick sauce, like macaroni and cheese or spaghetti bolognese, with pasta cut into small pieces.
Dinner: Shepherd's or cottage pie with a mashed potato topping. Tender casseroles or stews with meat and vegetables cooked until very soft and cut into the required size. Fish pie with a mashed potato topping and no bones.
Snacks and Desserts: Smooth puddings, mousse, rice pudding, or custard. Tinned fruit (peaches, pears) drained of thin liquid and cut into 1.5cm pieces. Soft sponge puddings with custard or cream.

Comparison: IDDSI Levels 5 and 6

Understanding the subtle but crucial differences between IDDSI Level 5 (Minced & Moist) and Level 6 (Soft & Bite-Sized) helps determine the correct dietary needs. While both provide texture modification, they cater to different levels of chewing ability.


Feature	IDDSI Level 5: Minced & Moist	IDDSI Level 6: Soft & Bite-Sized
Food Texture	Moist, with lumps no larger than 4mm for adults, mashed with a fork.	Soft, tender, and moist, with bite-sized pieces up to 15mm for adults.
Chewing Requirement	Minimal chewing is required, as the food can be broken down with tongue force.	Chewing is required before swallowing to break down the bite-sized pieces.
Biting Requirement	Not required.	Not required, but the person must be able to chew bite-sized pieces.
Preparation Method	Requires fine mincing or processing and mixing with sauce/gravy to ensure moisture.	Requires cooking until tender and then cutting to the correct bite-size.
Ideal For	People with reduced tongue control or moderate difficulty swallowing.	People with mild-to-moderate chewing difficulties, such as dental issues.

Why is Understanding Easy to Chew Level 6 Important?

For those caring for individuals with chewing or swallowing difficulties, accurately preparing meals to the correct IDDSI level is a matter of safety. Errors can lead to serious health complications, including choking or aspiration pneumonia, which occurs when food or liquid enters the lungs. The IDDSI framework, and specifically Level 6, provides clear, measurable standards that remove ambiguity and reduce risk. By following these guidelines, caregivers and healthcare providers can ensure meals are safe, enjoyable, and nutritious, improving the quality of life for those on a texture-modified diet. Regular monitoring and consultation with a healthcare professional, such as a Speech-Language Therapist or Dietitian, is recommended to ensure the individual is on the most appropriate diet level for their needs.

Conclusion

Easy to chew Level 6, or Soft & Bite-Sized, represents a crucial stage within the IDDSI framework for managing dysphagia and chewing difficulties. By adhering to strict guidelines on particle size, tenderness, and moisture, caregivers can prepare safe and appealing meals that reduce the risk of choking and aspiration. The simple fork pressure test and visual checks are essential tools for ensuring food is correctly prepared. For individuals navigating texture-modified diets, understanding and correctly implementing the requirements of Level 6 can significantly improve mealtime safety, nutrition, and overall well-being. Regular communication with a healthcare team is vital to adapt the diet as a person's chewing and swallowing abilities change.

Authoritative Outbound Link

For more detailed information on the IDDSI framework and its various levels, including comprehensive testing methods, visit the official website: IDDSI.org.

Frequently Asked Questions

The main difference is particle size and the chewing required. Level 5 food is minced to a 4mm lump size for adults and requires minimal chewing, while Level 6 is soft and cut into 1.5cm pieces, requiring more chewing.

Avoid hard, tough, chewy, or crunchy foods, as well as those with skins, seeds, husks, or gristle. Examples include nuts, hard fruit chunks like apple, raw vegetables, bread crusts, and dry, crumbly items.

Yes, but it must be a soft sandwich with the crusts removed and cut into small, bite-sized (1.5cm) pieces. The filling should also be soft and moist, like tuna or egg mayonnaise.

Meat and poultry should be cooked until very tender, with all bones and gristle removed. Then, cut it into bite-sized (1.5cm) pieces and serve it with plenty of thick gravy or sauce to ensure it is moist.

Regular dry bread is often a choking risk and not recommended. Some soaked or processed bread products may be suitable, but it is best to consult a healthcare professional, such as a Speech-Language Therapist.

The fork pressure test confirms that the food is soft enough to break apart easily in the mouth with minimal effort. This is a crucial safety check to ensure the food is appropriate for someone with chewing difficulties.

If food is too hard, too large, or contains thin liquid that separates, it can lead to a risk of choking or aspiration, which can cause aspiration pneumonia and other health complications.