Nutrition Diet: Is soft diet level 6? Unpacking the IDDSI Framework

October 18, 2025 •

3 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), Is soft diet level 6? Yes, it is, specifically known as 'Soft & Bite-Sized' and is designed for individuals with moderate chewing or swallowing difficulties. This global framework provides a universal system for describing modified food textures and liquids to enhance patient safety.

Quick Summary

Answering if a soft diet is Level 6, this article details the IDDSI Soft & Bite-Sized diet, exploring its specific texture requirements for those with chewing or swallowing issues, ensuring optimal nutrition.

Key Points

Level 6 Confirmation: Yes, the term 'soft diet' in a dysphagia context refers to IDDSI Level 6, officially known as 'Soft & Bite-Sized'.
Specific Texture: Level 6 foods are tender, moist, and require moderate chewing, but no biting off of larger pieces is necessary.
Bite-Sized Pieces: For adults, food must be cut into pieces no larger than 1.5 cm x 1.5 cm to minimize choking risk.
Fork Pressure Test: A key test for Level 6 involves mashing the food with a fork; it should break apart easily and retain its mashed shape.
Nutritional Adequacy: Despite texture modifications, a Level 6 diet can be nutritionally complete by including a variety of protein sources, grains, fruits, and vegetables.
Expert Guidance: A speech and language therapist and a dietitian should be consulted to determine if a Level 6 diet is appropriate and to ensure it is meeting nutritional needs.
Foods to Avoid: Tough, stringy, fibrous, crunchy, or crumbly foods, as well as those with skins, seeds, or gristle, must be avoided.

What is the IDDSI Framework?

The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global standard for describing modified food textures and liquid thickness. The framework uses eight levels, from 0 (thin liquids) to 7 (regular foods), with unique numbers, colors, and labels. This standardization improves safety by reducing confusion with terminology, especially for those with dysphagia.

Healthcare professionals, like speech and language therapists or dietitians, determine the correct IDDSI level for individuals. The framework balances prescriptive descriptions with a person-centered approach, aiming for the least restrictive, safest diet. The goal is to offer variety, improve quality of life, and ensure good nutrition.

Is Soft Diet Level 6? Understanding Soft & Bite-Sized

Yes, the soft diet aligns with IDDSI Level 6, named 'Soft & Bite-Sized'. This level suits individuals who can chew and control their tongue but struggle with larger or tougher foods. Food at this level mashes easily with moderate fork pressure. The 'bite-sized' rule helps lower choking risks.

Key features of IDDSI Level 6 food include:

Soft, tender, and moist: Food should be consistently tender without excess liquid. Sauces can add moisture and help bind food.
Easy to mash: Food should easily break down with a fork, spoon, or chopsticks.
Bite-sized pieces: Pieces for adults should not exceed 1.5 cm x 1.5 cm.
No tough textures: Avoid fibrous or chewy foods.
No small hard bits: Crunchy items, seeds, nuts, bones, and gristle are not allowed.

Comparison: IDDSI Level 6 vs. IDDSI Level 5

Comparing Level 6 to Level 5 (Minced & Moist) clarifies the differences in texture requirements.


Feature	IDDSI Level 6: Soft & Bite-Sized	IDDSI Level 5: Minced & Moist
Texture	Soft, tender, and moist pieces	Soft and moist, but with small lumps
Chewing	Moderate chewing is required.	Minimal chewing is required.
Lump Size (Adult)	Max 1.5 cm pieces.	Max 0.4 cm pieces.
Tongue Action	Needs tongue control to move food and hold bolus for chewing.	Lumps can be mashed with the tongue alone.
Key Test	Fork Pressure Test and Size Test: Food breaks down with fork pressure and pieces are correct size.	Fork Pressure Test: Lumps go through fork prongs and mash easily.
Preparation	Cut or chop into bite-sized pieces and add sauces/gravies.	Foods are minced or mashed to a uniform texture.

Ensuring Adequate Nutrition on a Soft & Bite-Sized Diet

Maintaining nutrition on a texture-modified diet is crucial, and a dietitian can help create a complete plan. Key nutritional points include:

Protein: Essential for recovery and muscle. Include tender meats, fish, eggs, soft cheeses, and cooked lentils.
Calories: To avoid weight loss, add energy-dense items like butter, full-fat dairy, or fortified milk powder.
Vitamins and Minerals: Get these from soft fruits and cooked vegetables.
Fiber: Important for digestion. Sources include well-cooked vegetables, some fruits, and porridge.
Hydration: Drink 6-8 glasses daily, including water, milk drinks, and juices.

Meal Planning for a Level 6 Diet

Planning enjoyable and nutritious meals that fit the consistency is important.

Suitable foods:

Protein: Soft fish, moist chicken or beef in sauce, tender meatballs, eggs, soft tofu, cooked lentils.
Grains/Starches: Cooked pasta in thick sauce, soft rice, mashed potatoes, porridge.
Fruits/Vegetables: Soft cooked vegetables (carrots, sweet potato) and soft, peeled fruits (bananas, stewed apples). Remove skins and seeds.
Dairy: Yogurt, soft cheeses, cottage cheese, milk puddings.
Desserts: Custards, soft sponge cakes with sauce, ice cream.

Foods to avoid:

Hard, dry, crunchy foods (nuts, crackers).
Fibrous or stringy foods (celery, pineapple).
Foods with skins, seeds (peas, corn).
Mixed-consistency foods (soups with large pieces).

Conclusion

A soft diet corresponds to IDDSI Level 6, Soft & Bite-Sized, which is vital for those with chewing and swallowing issues. By understanding the specific requirements and consulting with dietitians and speech therapists, a safe and nutritious diet can be created. Proper preparation and monitoring ensure nutritional needs are met while reducing choking and aspiration risks. Consulting a healthcare professional is key to starting a personalized plan. More IDDSI details are on their website.

Resources

The International Dysphagia Diet Standardisation Initiative (IDDSI) offers detailed guidelines and testing methods.

Frequently Asked Questions

IDDSI is a global framework with standardized terminology and definitions for food textures and liquid thicknesses, developed to improve safety for individuals with swallowing problems (dysphagia).

This diet is for individuals who have some chewing ability but cannot safely bite off larger pieces of food. They require soft, moist, and tender foods that are pre-cut into small pieces.

For adults, all food pieces must be no larger than 1.5 cm by 1.5 cm. For children, the size is smaller, at 0.8 cm by 0.8 cm.

You can perform a Fork Pressure Test. Press down on the food with a fork; it should easily mash and not return to its original shape when the pressure is removed.

Regular, dry bread is not suitable. Only plain white or wholemeal bread that has been finely chopped and soaked in a liquid like soup or sauce is permitted.

Avoid hard, tough, chewy, or stringy foods, as well as nuts, seeds, raw fruits and vegetables, and foods with skins or gristle. Mixed-consistency foods should also be avoided.

Focus on including a variety of soft protein sources, well-cooked starches and vegetables, and soft fruits. Use methods like food fortification by adding full-fat dairy, butter, or fortified milk powder to boost calories and nutrients.