What is the IDDSI Framework?
For individuals with chewing or swallowing difficulties, known as dysphagia, the International Dysphagia Diet Standardisation Initiative (IDDSI) provides a globally recognized framework. This framework uses a common set of descriptors for food textures and drink thicknesses, helping to eliminate confusion and improve patient safety across different care settings. The IDDSI framework ranges from Level 0 (Thin) to Level 7 (Regular), with Level 5 designated as 'Minced and Moist'.
Characteristics of an IDDSI Level 5 Diet
Level 5 is designed for people who have minimal chewing ability and sufficient tongue control to form a food ball (bolus) before swallowing. The key characteristics of this food texture are:
- Soft and Moist: The food must be moist throughout, held together with thick, smooth gravy or sauce, with no separating thin liquid.
- No Hard Lumps: The food must not contain any hard or tough pieces, dry crumbs, or fibrous bits.
- Easy to Mash: Food should be easily mashed with light pressure from a fork, and any small lumps should be easily broken down by the tongue.
- Cohesive: Food should stick together when scooped but fall apart easily when a spoon is tilted or flicked, without being sticky in the mouth.
The Permitted Food Size on a Level 5 Diet
The most crucial aspect of the minced and moist diet is adhering to the strict particle size guidelines. These measurements are in place to ensure food can be safely swallowed with minimal risk of choking.
Food Size for Adults
For adults on a Level 5 diet, food pieces should be no larger than 4mm in width. This size is approximately the same as the width between the prongs of a standard dinner fork, which is used as a simple visual test. The food should be soft and tender enough to be easily minced or mashed to this size.
Food Size for Children
For children, the requirements are even stricter, with a maximum particle size of 2mm. This is a safety measure to account for smaller airways in pediatric patients. Caregivers should ensure that all food is prepared to this finer mince or mash.
Comparison of Food Textures (IDDSI Levels 4, 5, and 6)
| Feature | Level 4: Pureed | Level 5: Minced & Moist | Level 6: Soft & Bite-Sized |
|---|---|---|---|
| Particle Size | No lumps; smooth texture | Adult: $\leq$ 4mm, Child: $\leq$ 2mm | Bite-sized pieces, $\leq$ 1.5cm |
| Biting Required? | No | No | Yes, minimal |
| Chewing Required? | No | Minimal | Yes, minimal |
| Moisture Level | Very moist and cohesive | Moist throughout, no separating liquid | Moist, but no free liquid |
| Typical Foods | Blended soups, smooth yogurt, pureed meats | Cottage pie, mashed vegetables, minced meat in gravy | Soft pasta, tender cooked vegetables, soft sandwiches |
| Fork Test | Cannot hold shape on a fork | Forms a cohesive ball, mashes easily | Holds shape on fork, separates cleanly |
How to Prepare Food for a Level 5 Diet
Preparing food to the correct texture and moisture is essential for safety. Here are practical steps to achieve the minced and moist consistency:
Equipment and Techniques
- Mincing and Mashing: Use a food processor, hand mincer, or a sturdy fork to break down foods to the required size.
- Adding Moisture: Incorporate thick sauces, gravies, milk, or broth to prevent food from becoming dry and crumbly. Avoid adding plain water, which can dilute nutrients.
- Fortification: To increase nutritional content, add extra protein or energy by mixing in ingredients like butter, cheese, or protein powder.
Tips for Different Food Groups
- Protein: Finely mince cooked meat, poultry, or fish, and mix with a thick, smooth sauce. Ensure all bones, skin, and gristle are removed. Mashed eggs or soft tofu are also suitable.
- Vegetables: Cook vegetables like carrots, squash, or potatoes until very soft, then mash or finely chop. Drain excess liquid and add moisture with butter, cream, or a thick sauce.
- Starches: Mashed potatoes, soft well-cooked rice, or minced pasta can be used. Ensure cereals are fully soaked and moist, with no separate liquid.
- Fruit: Use soft, ripe, and peeled fruits like bananas, peaches, or kiwi. Mash them or use a blender, and drain any excess juice. Avoid fibrous or stringy fruits.
- Dairy: Smooth yogurt, cottage cheese, cream cheese, and cheese sauces are good options.
Conclusion: Prioritizing Safety and Nutrition
The IDDSI Level 5 minced and moist diet provides a safe and effective way for individuals with swallowing difficulties to consume a variety of nutritious foods. By meticulously following the size guidelines—4mm for adults and 2mm for children—and ensuring the correct moist consistency, caregivers can significantly reduce the risk of choking and aspiration. This framework not only prioritizes safety but also helps maintain nutritional intake and quality of life. For further guidance and resources, it is always recommended to consult with a healthcare professional, such as a Speech-Language Pathologist or Dietitian. Additional information can also be found on the IDDSI website [www.iddsi.org].
It is important to remember that these guidelines serve as a foundation for safe preparation. Consistency checks, such as the fork and spoon tests, should be part of the routine to ensure food is served correctly.
