Understanding the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative (IDDSI) was created to establish a universal language for describing food textures and drink thickness for people with dysphagia, or swallowing difficulties. The framework uses a numbered and color-coded system from level 0 (thin liquids) to level 7 (regular foods) to reduce confusion and enhance patient safety. Level 6, colored blue, is a crucial step for many individuals in their dietary progression.
What Defines Level 6 Soft and Bite Sized Foods?
For a food to be classified as Level 6 'Soft and Bite-Sized', it must meet several specific criteria, which can be easily tested at home. The main purpose is to reduce the risk of choking for those with limited ability to bite or chew.
- Particle Size: For adults, food pieces must be no larger than 1.5 cm by 1.5 cm, roughly the width of a standard dinner fork. For children, the pieces should be no larger than 8 mm.
- Texture and Moisture: The food must be soft, tender, and moist throughout. It should have no separate, thin liquid leaking from it, as this can increase choking risk.
- Ease of Mashing: A key test is that the food can be easily mashed or broken down with pressure from a fork or spoon. When you press on the food with a fork until your thumbnail turns white, the food should squash and not regain its original shape.
- No Biting Required: The food pieces should be ready to eat without needing to bite off a portion. Chewing is still required, but it should be a manageable amount.
Preparing Meals for a Level 6 Diet
Preparing level 6 meals involves careful cooking and cutting to achieve the right texture and size. The focus is on moist, tender ingredients and the avoidance of tricky textures.
- Protein: Tender meats like slow-cooked chicken, fish without bones, or soft beef should be chopped into the correct bite-sized pieces. Fried or breaded items are generally not suitable.
- Fruits: Soft, peeled fruits such as ripe bananas, cooked apples, or tinned peaches are suitable. Ensure all skins, pips, and fibrous parts are removed.
- Vegetables: Vegetables should be boiled or steamed until very soft and then cut into the appropriate size. Stir-fried vegetables are often too firm.
- Carbohydrates: Well-cooked pasta or soft rice is acceptable, but it must be served in a thick, smooth sauce to prevent grains from separating. Baked potatoes can be included, but the skin must be discarded.
- Cereals: Cereals like porridge or soaked breakfast flakes are fine, provided they are fully softened with milk and any excess liquid is drained.
- Sauces and Gravies: Use thick, smooth sauces, gravies, or creamy custards to add moisture and help bind food together.
Comparison: Level 6 vs. Level 5 Foods
The IDDSI framework has a clear progression, and understanding the difference between Level 6 and its preceding level is vital for patient safety.
| Feature | IDDSI Level 6 (Soft and Bite-Sized) | IDDSI Level 5 (Minced and Moist) |
|---|---|---|
| Particle Size | Adult pieces no larger than 1.5 cm x 1.5 cm; Child pieces no larger than 8 mm. | Adult pieces no larger than 4 mm; Child pieces no larger than 2 mm. |
| Texture | Soft, tender, and moist, with distinct bite-sized lumps. | Lumps are soft and very small, completely covered in a moist, non-sticky sauce. |
| Testing Method | Food squashes easily with a fork and retains its bite-sized shape. | Food squashes with a fork and holds its shape, not sticky or separate. |
| Chewing Requirement | Requires moderate chewing. | Requires minimal chewing. |
| Purpose | For individuals who can chew small, soft pieces but cannot bite off larger portions. | For individuals with reduced chewing ability and weaker tongue control. |
Foods to Avoid on a Level 6 Diet
To ensure safety, certain food types must be avoided entirely or prepared with extra care. These include:
- Hard or Dry Textures: Things like hard chunks of cheese, nuts, seeds, raw vegetables, or dry cake.
- Tough or Stringy Foods: Meat with gristle, pineapple, celery, or runner beans.
- Sticky Foods: Such as peanut butter or chewy sweets.
- Crumbly Foods: Bread crusts, flaky pastries, or dry biscuits.
- Mixed Consistencies: Foods that have both thin liquid and solid lumps, like watery soup with chunks.
- High-Risk Shapes: Round, hard foods like grapes or whole cherry tomatoes, which are choking hazards, should be cut.
Conclusion
Level 6 soft and bite sized foods, as defined by the IDDSI, play a critical role in providing safe and nutritious meals for people with dysphagia. Adhering to the specific size, moisture, and softness standards reduces choking risks while still allowing for a varied and appealing diet. Correct meal preparation and consistent testing are paramount for ensuring individuals receive the right texture to support their chewing and swallowing abilities. For personalized dietary advice, it is always recommended to consult with a healthcare professional, such as a Speech and Language Therapist or a Dietitian. For more information on the full framework, visit the official IDDSI website.
International Dysphagia Diet Standardisation Initiative (IDDSI)
