The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a standardized framework of eight levels (0-7) to describe food textures and drink thicknesses for individuals with dysphagia (swallowing difficulties). Level 6 soft foods, officially termed "Soft & Bite-Sized," are designed for people who can chew but may have difficulty biting off larger pieces or tire easily during meals.
Characteristics of Level 6 Soft Foods
Foods at IDDSI Level 6 must meet specific criteria to be considered safe.
- Soft and Tender: Foods must be soft, tender, and moist throughout.
- Bite-Sized Pieces: Food pieces must be no larger than 1.5 cm x 1.5 cm (about 0.59 inches) for adults and 0.8 cm x 0.8 cm for children, roughly the width of a standard fork.
- Easily Mashable: When pressed with the side of a fork or spoon, the food should break apart easily and not return to its original shape.
- No Separate Thin Liquid: Foods should not have thin liquid leaking or dripping from them, as mixed consistencies can increase the risk of aspiration.
- Chewing Required: While biting is not necessary, moderate chewing is required before swallowing.
- No Hard or Stringy Elements: Foods must be free from hard bits, tough textures, skins, seeds, pips, bones, or gristle.
Suitable Foods and Foods to Avoid
Careful selection and preparation are crucial for an IDDSI Level 6 diet.
Recommended Foods (Prepared to 1.5 cm)
- Meats: Slow-cooked, tender meats (beef, pork, chicken) chopped finely, or minced meat in thick gravy.
- Fish: Skinless, boneless fish cooked until soft and flaked in a thick sauce.
- Vegetables: Boiled or steamed vegetables like carrots, swedes, cauliflower, and sweet potatoes, cut to size.
- Starches: Well-cooked pasta (e.g., macaroni, ravioli) in a thick sauce, or mashed potatoes (no skins). Porridge or instant cereals fully soaked in milk.
- Fruits: Soft, peeled fresh fruits such as bananas, avocados, and strawberries, or drained canned fruit (peaches, pears) cut into small pieces.
- Desserts: Soft sponge cake with cream or custard, milk puddings, mousses, and yogurts (without bits).
Foods to Avoid
- Hard, tough, chewy, or stringy meats (like steak or bacon).
- Foods with skins (peas, grapes, sausages) or seeds/pips.
- Crumbly foods (dry biscuits, pastry, toast, dry cake).
- Mixed consistencies (cereal in thin milk, soup with lumps).
- Sticky foods (marshmallows, some nut butters unless blended).
- Hard foods (nuts, boiled sweets).
- Bread is generally not recommended unless assessed by a speech therapist due to variable texture.
Comparison Table: IDDSI Levels 5 and 6
Understanding the difference between adjacent levels is important.
| Feature | Level 5 (Minced & Moist) | Level 6 (Soft & Bite-Sized) |
|---|---|---|
| Particle Size (Adults) | Lumps no bigger than 4 mm. | Pieces no bigger than 1.5 cm. |
| Texture | Soft, moist, and easily squashed with the tongue. | Soft, tender, and moist throughout. |
| Chewing Required? | Minimal (tongue can mash). | Yes, moderate chewing is required. |
| Biting Required? | No. | No (food is pre-sized). |
| Cohesion | Forms a cohesive ball, but does not stick. | Forms a cohesive bolus for swallowing. |
Preparation Techniques for Level 6
To prepare safe Level 6 foods, ensure items are thoroughly cooked (boiled, steamed, slow-cooked) to achieve tenderness. Use a food processor to cut ingredients to the appropriate size if necessary, but avoid pureeing. Add thick, smooth sauces or gravy to maintain moisture and bind the food without creating thin liquid separation. Always perform the fork pressure test before serving.
Conclusion
Adhering to a Level 6 soft food diet, as defined by IDDSI, is a critical safety measure for individuals with specific chewing and swallowing difficulties. This diet requires foods to be soft, moist, and precisely cut into bite-sized pieces to minimize the risk of choking and aspiration while still allowing for a varied and nutritious intake. Close consultation with healthcare professionals, such as speech and language therapists and dietitians, is essential to ensure the diet is appropriate and nutritionally adequate.
