What Best Describes a Level 6 Texture Modified Diet?

November 19, 2025 •

4 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a level 6 texture modified diet is officially known as 'Soft and Bite-Sized'. This food texture is characterized by soft, tender, and moist foods that are cut into specific, safe-to-swallow pieces, and is prescribed for individuals with certain chewing and swallowing difficulties.

Quick Summary

This article explains the characteristics of a Level 6 'Soft and Bite-Sized' diet, including food size, texture, and preparation methods. It also covers who might require this diet and outlines which foods should be avoided to minimize choking risk.

Key Points

Diet Description: A Level 6 diet is medically known as 'Soft and Bite-Sized' and features food that is soft, tender, moist, and cut into small pieces.
Particle Size: For adults, food must be cut into pieces no larger than 1.5 cm x 1.5 cm, while for children, the maximum size is 8 mm x 8 mm.
Required Chew: This diet requires moderate chewing ability, as individuals must be able to break down the bite-sized pieces before swallowing.
Moisture and Texture: Foods must be consistently moist with no separate thin liquids, and soft enough to be mashed easily with a fork.
Foods to Avoid: Hard, chewy, stringy, crunchy, or crumbly foods are unsafe, along with nuts, seeds, and skins.
Safety First: The IDDSI framework provides standardized, color-coded guidelines to ensure food texture is consistent and reduces the risk of choking.
Preparation: Proper preparation includes thoroughly cooking and cutting foods to size, and serving them with thick, smooth sauces or gravies.

Understanding the 'Soft and Bite-Sized' Diet

What best describes a level 6 texture modified diet is a food texture that is soft, moist, and cut into small, bite-sized pieces. As defined by the International Dysphagia Diet Standardisation Initiative (IDDSI), this diet is medically prescribed for individuals who have difficulty chewing or biting larger pieces of food but possess enough tongue control to safely manage smaller, pre-cut pieces. The IDDSI framework provides clear, standardized descriptors and testing methods to ensure consistency and safety, reducing the risk of choking and aspiration.

Key characteristics of a Level 6 diet

A Level 6 diet is highly specific to ensure safety while maximizing nutritional intake and enjoyment. Key characteristics include:

Particle Size: For adults, food pieces should be no larger than 1.5 cm x 1.5 cm (about a half-inch). This size is roughly the width of a standard dinner fork. For children, the safe size is smaller, at 8 mm x 8 mm.
Moisture Content: All foods must be moist and tender throughout. Excess thin liquid, such as watery sauces or juices, is avoided because it can separate from the solid food in the mouth and cause choking.
Softness: The food must be soft enough to be broken down easily with pressure from a fork or spoon, without requiring a knife to cut. The fork pressure test is a standard method to verify this consistency.
Non-Sticky: Food should not be sticky or gluey, as this can make it difficult to clear from the mouth.
Chewing Required: Unlike pureed or minced diets, a Level 6 diet still requires some chewing ability to break the food down before swallowing.

The Importance of the IDDSI Framework

Before the IDDSI framework was globally adopted, terms like "soft" or "chopped" were interpreted inconsistently across different healthcare settings, leading to a higher risk of adverse events like choking. The IDDSI's standardized terminology and testing methods have significantly improved patient safety by ensuring that healthcare professionals, food service providers, and caregivers are all following the same guidelines. The blue color coding and level number 6 also help to quickly identify and prepare the correct diet.

How to prepare Level 6 foods

Preparing a Level 6 diet involves selecting appropriate foods and modifying their texture to meet the specific requirements.

Cook Thoroughly: Meats and vegetables should be cooked until very tender. Slow-cooking meats can help achieve the desired softness.
Cut Precisely: Use a food processor or knife to cut solid foods into pieces no larger than 1.5 cm for adults. Cutting meats against the grain can also improve tenderness.
Add Moisture: Always serve foods with a thick, smooth sauce or gravy to prevent them from becoming dry and crumbly. Examples include chicken casserole with gravy or pasta with a thick bolognese sauce.
Soften Starches: Cereals like porridge or Weetabix should be fully soaked in milk, with any excess fluid drained before serving. Cook pasta and rice until very soft and serve with a thick sauce that binds the grains together.

Comparison of IDDSI Level 6 with Other Levels


Feature	IDDSI Level 5: Minced and Moist	IDDSI Level 6: Soft and Bite-Sized	IDDSI Level 7: Regular Easy Chew
Appearance	Uniform, moist, cohesive lumps that are easily mashed with a fork.	Moist, tender, bite-sized pieces (1.5cm for adults) with no separate thin liquid.	Normal, soft, and tender everyday food with no size restriction.
Chewing Required?	No significant chewing required.	Requires moderate chewing before swallowing.	Requires chewing.
Fork Pressure Test	Easily mashes with pressure from a fork; lumps hold together.	Easily mashes with pressure from a fork; holds shape but yields easily.	No specific fork pressure test required; food is soft and tender.
Food Example	Cottage pie with gravy, scrambled eggs with sauce, moist tuna salad.	Chicken casserole with vegetables, well-cooked pasta with thick sauce.	Tender roast meat, soft bread (no crust), chopped salad.
Purpose	For individuals who cannot chew but have some oral motor control.	For individuals who can chew small, soft pieces but cannot safely bite off larger portions.	For those who can chew but need foods that are easy to manage.

Conclusion

A level 6 texture modified diet, known as 'Soft and Bite-Sized' under the IDDSI framework, is a crucial dietary management strategy for individuals with dysphagia who can chew but cannot safely manage larger or tougher food pieces. By adhering to strict guidelines for food size, softness, and moisture, this diet reduces the risk of choking and aspiration while providing variety and promoting proper nutrition. Consultation with a speech and language therapist or dietitian is essential for a precise and safe dietary plan tailored to individual needs. Following these guidelines ensures that eating remains a safe and pleasant experience for those with swallowing difficulties. For more information, visit the International Dysphagia Diet Standardisation Initiative website.

Frequently Asked Questions

This diet is recommended for individuals with mild swallowing difficulties (dysphagia) or limited chewing ability due to fatigue, pain, or dental issues.

For adults, bite-sized pieces should be no larger than 1.5 cm x 1.5 cm. For children, the recommended maximum size is 8 mm x 8 mm.

The IDDSI fork pressure test is used. A food sample should squash and change shape easily when pressed with the side of a fork or spoon, and not return to its original shape when the pressure is released.

Regular dry bread or toast is not recommended due to a high choking risk. Plain white or wholemeal bread can be eaten if finely chopped, soaked in sauce, or served as a blended slurry.

Fruits with high water content, such as watermelon and oranges, should be approached with caution as the thin juice can separate from the solids in the mouth, creating a mixed consistency that increases choking risk.

To increase calories, add nourishing ingredients like full-fat dairy, cream, butter, or mayonnaise to foods. High-calorie drinks like milkshakes can also be helpful.

The need for thickened fluids is assessed and prescribed separately by a speech and language therapist. The consistency of fluids and foods are managed independently based on the individual's needs.