Understanding the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global standard for terminology used to describe food textures and drink thickness for individuals with swallowing difficulties, or dysphagia. The framework consists of eight levels, with Level 7 representing regular texture foods. Within this level, there are two sub-categories: Regular and Regular Easy to Chew. While the Regular diet is for those with no chewing or swallowing problems, the Easy to Chew diet provides a specific, softer texture for those who require less effort to chew.
This specific diet level accommodates individuals who may experience pain or fatigue while chewing harder foods but do not have an increased risk of choking. Reasons for this requirement can range from dental issues and missing teeth to recovering from illness or simply having weaker chewing muscles. The focus is on providing nutritious, appealing meals that are safe and enjoyable to eat without compromising on flavour.
Key Characteristics of Level 7 Easy to Chew Foods
Level 7 Easy to Chew foods are defined by their soft and tender texture. Unlike other modified diets, there are no restrictions on the size of the food pieces, allowing for a more normal eating experience. The key is that the food must be easily broken down in the mouth with minimal effort. This is verified by a simple fork pressure test during preparation.
To pass the test, food should be able to be squashed and break apart easily with the side of a fork or spoon. If you press down on the food with a fork until your thumbnail turns white, the food should remain squashed and not regain its original shape. This ensures the food is tender enough to be safely managed.
Foods Included in a Level 7 Easy to Chew Diet
This diet includes many everyday items, provided they are cooked or prepared to the correct tenderness.
- Tender Meats: Slow-cooked stews, casseroles, meatballs, ground meat dishes, tender fish cooked until it flakes easily. Ensure all bones and gristle are removed.
- Soft Fruits: Bananas, very ripe pears, stewed or tinned fruits (peeled), and berries. Avoid fibrous parts like orange pith.
- Soft Vegetables: Steamed or boiled vegetables like carrots, cauliflower, pumpkin, and parsnips that can be easily mashed with a fork.
- Starches: Soft, well-cooked pasta, rice, and potatoes prepared in various soft forms, such as mashed, boiled, or baked (insides only). Soft sandwiches with smooth, moist fillings are also suitable.
- Dairy: Yogurt, cottage cheese, soft cheeses, and milk puddings.
- Cereals: Porridge or breakfast cereals softened with milk.
- Moisture Enhancers: Sauces, gravy, and butter can be added to increase moisture and palatability.
Foods to Avoid on a Level 7 Easy to Chew Diet
Certain food characteristics pose a risk and should be avoided.
- Hard or Dry: Nuts, dry cereals, bread crusts, and raw vegetables.
- Tough or Fibrous: Steak, pineapple, celery, runner beans, and rhubarb.
- Chewy or Sticky: Chewy candy, dried fruits, marshmallows, or thick, sticky mashed potatoes.
- Crunchy or Crumbly: Raw apples, crackers, toast, crisps, and flaky pastries.
- Pips, Seeds, and Gristle: Seeds from fruits or bread, pips, and bony pieces.
- Mixed Textures: Foods that contain a mix of thin liquids and solid pieces, such as soup with chunks or cereal in milk, can be unsafe for some individuals. Check with a clinician for guidance on this.
Comparison: Level 7 Easy to Chew vs. Regular
| Feature | Level 7 Regular | Level 7 Easy to Chew |
|---|---|---|
| Chewing Ability | Normal, no issues with hard, chewy foods. | Needs softer textures; struggles with hard/firm foods without tiring. |
| Texture Requirements | No texture restrictions. Foods can be hard, crunchy, or chewy. | Foods must be soft and tender, easily mashed with a fork. |
| Particle Size | No restrictions on food piece size. | No restrictions on food piece size. |
| Examples | Steak, raw carrots, apples, nuts, hard breads. | Tender meats, soft vegetables, ripe fruits, soft pasta. |
| Choking Risk | No identified increased risk of choking. | No identified increased risk of choking, but requires supervision for those with unsafe mealtime behaviors. |
| Target Population | General population without chewing or swallowing problems. | Individuals with weaker chewing ability due to age, fatigue, or dental status. |
Cooking and Preparation Tips
Making meals for a Level 7 Easy to Chew diet can be simple and delicious. Here are some tips:
- Use Moist Cooking Methods: Braising, simmering, and slow cooking are excellent for making meats tender and moist. Adding sauces or gravy can further soften the final product.
- Add Flavour: Pureeing or mashing foods can sometimes dilute their flavour. Use herbs, spices, stock, or concentrated juices to enhance taste. Roasting vegetables before pureeing can intensify their flavour profile.
- Boost Nutrition: To counteract potential low intake, enrich foods with full-fat dairy products like cream, butter, and cheese. Adding milk powder to sauces or using high-calorie drinks like milkshakes can also help.
- Prioritize Presentation: Visual appeal can greatly impact appetite. Use piping bags to shape mashed potatoes or other purees, or simply add colorful garnishes to make meals look more appealing.
- Test for Safety: Always perform the fork pressure test on food at the serving temperature, as consistency can change when hot or cold. This quick check ensures the food is safe to eat.
Conclusion
Answering what are level 7 foods involves understanding the specific Easy to Chew category within the IDDSI framework. This modified diet provides a safe and comfortable eating experience for individuals with weaker chewing muscles, ensuring they receive proper nutrition without the risks associated with harder textures. By focusing on soft, tender, and moist foods, and using simple testing methods, caregivers and diners can navigate this dietary plan with confidence. The key is mindful preparation that prioritizes both safety and flavour, making mealtimes an enjoyable experience. For more detailed information on the IDDSI framework, consult the IDDSI website.
