What are the critical IDDSI testing methods for IDDSI level 6?

October 22, 2025 •

5 min read

Over 590 million people globally are affected by dysphagia, necessitating strict adherence to standardized food preparation to prevent choking and aspiration. A key component of this is understanding the critical IDDSI testing methods for IDDSI level 6, which ensures food is safe for individuals with moderate chewing abilities.

Quick Summary

This article explains the two critical International Dysphagia Diet Standardisation Initiative tests for the Soft and Bite-Sized diet: the fork pressure test for softness and the particle size check for appropriate dimensions. It details the step-by-step procedures and compares them with other levels.

Key Points

Pressure Test: The Fork/Spoon Pressure Test is critical for IDDSI Level 6 to ensure the food is soft enough to be squashed with a fork and won't return to its original shape.
Particle Size Test: Food pieces for adults on IDDSI Level 6 must be no larger than 1.5 cm by 1.5 cm, which can be checked using the length of a standard fork's tines.
Visual Inspection: Before testing, food for IDDSI Level 6 must appear soft, moist, and tender, without any separate thin liquid leaking or dripping.
Appropriate Pressure: The pressure applied during the fork/spoon test should be enough to cause the thumbnail to blanch white, mimicking the pressure of swallowing.
No Rebound: A successful fork pressure test means the food stays mashed and doesn't spring back to its original shape after the utensil is removed.
Chewing Required: Unlike lower levels, IDDSI Level 6 assumes the patient has some chewing ability to safely manage the bite-sized pieces.

Understanding IDDSI Level 6: Soft and Bite-Sized

IDDSI Level 6, known as 'Soft and Bite-Sized', is designed for individuals with dysphagia who can chew but have difficulty managing food pieces that are tough, hard, or larger than a specific size. The food must be soft, tender, and moist, with no separate thin liquid. The primary goal is to provide a diet with minimal choking risk while allowing for a more varied and palatable eating experience than pureed or minced diets. This level is for people who can't safely bite off pieces of food but can chew smaller, already-prepared portions. The key characteristics include easily mashed food and appropriately-sized pieces, making the correct application of the critical IDDSI testing methods for IDDSI level 6 vital for patient safety.

The Critical IDDSI Testing Methods for IDDSI Level 6

For IDDSI Level 6, two tests are considered critical for compliance: the Fork or Spoon Pressure Test and the Particle Size Test. These simple, objective tests use standard kitchen utensils to ensure food texture and dimensions meet safety requirements. Both tests must be performed on the food at the temperature it will be served, as temperature can affect consistency.

Method 1: The Fork or Spoon Pressure Test

This test is used to confirm the food's softness and moisture level. The procedure involves applying pressure to a food sample and observing its reaction. The steps are as follows:

Prepare the sample: Take a 1.5 cm x 1.5 cm piece of food (the standard size for adults) and place it on a flat plate.
Apply pressure: Press down on the food using the base of a metal fork or spoon. A standardized amount of pressure is applied by pressing until the thumbnail on your thumb, which is applying the force, blanches white.
Observe the outcome: The food sample should squash easily and change shape under the pressure.
Release pressure: When you lift the fork or spoon, the food should not return to its original shape.

If the food sample resists being squashed, or if it springs back to its original shape, it is not soft enough for IDDSI Level 6 and presents a choking risk.

Method 2: The Particle Size Test

This test verifies that all food pieces are within the safe 'bite-sized' dimensions. For adults, this means no single piece should be larger than 1.5 cm x 1.5 cm. A standard metal fork can be used as a convenient measurement tool, as the length of the tines is typically about 1.5 cm.

Select a sample: Isolate a representative piece of the cooked food you are testing.
Use the fork as a guide: Hold the piece of food next to the tines of a standard metal dinner fork.
Check the dimensions: If the piece of food is wider than the four tines of the fork or longer than the tines, it is too large and must be cut smaller.
Repeat as necessary: Check several pieces to ensure consistency throughout the meal.

Step-by-Step Testing Procedure

Following a simple procedure ensures reliable and consistent results when testing food for IDDSI Level 6.

Step 1: Visual Inspection. First, check that the food is soft, tender, and moist throughout. Ensure there are no separate thin liquids pooling around the food.
Step 2: Particle Size Test. Using a standard metal fork, confirm that all food pieces are no larger than 1.5 cm in width or length.
Step 3: Fork/Spoon Pressure Test. Press down on a food sample with a fork or spoon using enough pressure to make your thumbnail blanch white. The food should deform easily and not spring back.
Step 4: Separation Test (Optional but useful). Test the food's ability to be broken apart with the side of a fork or spoon. It should cut or break easily without much effort.
Step 5: Test at serving temperature. Repeat the pressure test just before serving. Some foods can change texture as they cool or are held for a period.

Comparison of Testing Methods for IDDSI Levels 5 and 6

Understanding the differences between levels is key to proper application. Level 5 (Minced and Moist) and Level 6 (Soft and Bite-Sized) require distinct testing criteria. This table highlights the key differences.


Feature	IDDSI Level 5 (Minced & Moist)	IDDSI Level 6 (Soft & Bite-Sized)
Particle Size	Pieces no larger than 4 mm (width of fork tines).	Pieces no larger than 1.5 cm (length of fork tines).
Softness Test	Can be easily mashed with a fork with light pressure (no thumbnail blanching).	Requires more pressure (thumbnail blanches white) to mash with a fork.
Pressure Test Outcome	Food particles separate and fall through the tines when mashed.	Food mashes and changes shape, but does not fall through the tines.
Moisture/Cohesiveness	Food holds a cohesive shape but is moist and does not flow freely through fork.	Soft, tender, and moist throughout, with no separate thin liquid leaking.
Chewing Ability	Not required to chew bite-sized pieces; tongue mashes.	Requires some chewing before swallowing.

Important Considerations for IDDSI Level 6

Proper testing is just one aspect of preparing safe IDDSI Level 6 food. Other factors must be considered to prevent complications.

Maintain Moisture: The food must remain moist throughout the eating process. Dry foods are not appropriate for this level, as they can be difficult to manage.
Consistency in Sauces: If a sauce or gravy is used, it should be thick enough to hold together with the solid food and not separate into a thin liquid, which could increase aspiration risk.
Avoid Problematic Foods: Certain foods pose a hazard even when softened. These include tough, fibrous, or stringy foods; hard, crunchy items; and sticky foods. Food with skins, bones, or gristle must be avoided.
Temperature Matters: Re-test consistency if the food temperature changes significantly from preparation to service. A food that is soft when hot might harden as it cools.

Conclusion: Ensuring Safety and Quality with IDDSI

Accurate application of the critical IDDSI testing methods for IDDSI level 6 is a fundamental step in managing dysphagia and ensuring patient safety. The Fork/Spoon Pressure Test confirms the required softness, while the Particle Size Test ensures that food pieces are appropriately small. Adherence to these simple, practical methods, along with maintaining appropriate moisture and avoiding problematic food types, empowers caregivers and food service professionals to provide safe, consistent, and dignified meals for those with swallowing difficulties. Regular testing and training are essential to maintain these high standards and protect vulnerable individuals. For comprehensive information and resources on IDDSI, visit the official website: International Dysphagia Diet Standardisation Initiative.

Frequently Asked Questions

The primary objective is to verify that food is soft, tender, moist, and cut into safe, bite-sized pieces (1.5 cm x 1.5 cm for adults) to minimize the risk of choking for individuals with dysphagia who can chew but have difficulty with tough or large food.

To perform the Fork Pressure Test, take a 1.5 cm x 1.5 cm food sample and press down with the base of a metal fork until your thumbnail blanches white. The food should squash easily and not return to its original shape when the pressure is released.

The Particle Size Test is crucial because it ensures that all food pieces are within a safe, predetermined size (1.5 cm x 1.5 cm for adults). This size is small enough to be safely managed and chewed by individuals with moderate chewing abilities, reducing the risk of choking.

It is recommended to use a standard metal dinner fork for IDDSI testing, as the spacing and size of the tines are standardized and reliably used as a reference for particle size. A metal fork also provides a consistent amount of pressure when testing for softness.

Moisture is checked visually. The food should be soft, tender, and moist throughout, with no separate, thin liquid leaking or dripping from it. Excessively dry or watery food is not compliant with IDDSI Level 6 guidelines.

Foods to avoid include tough or chewy meats, fibrous or stringy vegetables, crunchy items like nuts or crackers, and sticky foods like peanut butter. Any food with bones, gristle, or skins must also be removed.

The key difference is the amount of pressure applied. For Level 5, the pressure is light and does not make your thumbnail blanch. For Level 6, you must apply enough pressure to make your thumbnail blanch white, demonstrating that the food is still soft but requires more force to break down than Level 5.