What does a level 6 diet consist of?: A guide to the soft and bite-sized dysphagia diet

October 25, 2025 •

4 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), up to 8% of the world's population may have some form of dysphagia, or difficulty swallowing. For those with milder challenges, knowing precisely what does a level 6 diet consist of is crucial for safely and comfortably enjoying meals.

Quick Summary

The IDDSI Level 6, or Soft and Bite-Sized diet, features foods that are soft, tender, and moist, with small, controlled particle sizes. It is prescribed for individuals with mild chewing or swallowing difficulties who still have some chewing ability but cannot safely manage larger, harder food pieces.

Key Points

International Standard: A level 6 diet follows the global IDDSI Soft and Bite-Sized guidelines, which standardize food textures for safety.
Precise Sizing: Food pieces must be no larger than 15mm x 15mm for adults to minimize choking risk.
Soft and Moist: All food must be soft, tender, and moist throughout, easily mashed with a fork.
Chewing Required: This diet is for individuals who have mild chewing difficulties but still possess some chewing ability.
No Mixed Textures: Avoid foods that produce both thin liquid and solid particles in the mouth, as these are a choking hazard.
Professional Guidance: A speech pathologist and dietitian should recommend and monitor the diet to ensure safety and nutritional adequacy.
Nutrient Fortification: Extra nutrition can be added by using full-fat dairy, cream, and cheese to fortify meals and boost calorie intake.

Understanding the IDDSI Framework and Level 6

The International Dysphagia Diet Standardisation Initiative (IDDSI) created a global framework to classify food textures and drink thicknesses for people with swallowing difficulties (dysphagia). This standard helps ensure consistency and safety for patients by eliminating the confusion caused by varied, non-standardized terminology. The IDDSI framework uses eight levels (0-7), with Level 6 representing the Soft and Bite-Sized food texture.

What Defines a Soft and Bite-Sized Diet?

The Level 6 diet is characterized by its specific texture and particle size to make it easy to chew and safer to swallow, but it still requires some chewing. Key characteristics include:

Soft, tender, and moist throughout: Food should not be dry, crumbly, or have separate thin liquids, like watery sauces, which could pose a choking risk.
Precise particle size: For adults, all food pieces must be no larger than 15mm x 15mm, roughly the width of a standard dinner fork. For children under five, the maximum size is smaller at 8mm x 8mm.
Easily mashed: Food should break apart easily under pressure from a fork or spoon, without returning to its original shape.
Requires moderate chewing: This diet is not for individuals who cannot chew at all, but rather for those who experience pain, fatigue, or difficulty with harder, larger foods.

How to test food for Level 6 compliance

To ensure food meets the Level 6 criteria, a simple fork pressure test can be performed:

Take a small sample of the food (the size of an adult thumbnail, approximately 15mm x 15mm).
Press down on the food with the side of a fork or spoon until the nail on your thumb turns white from the pressure.
The food should mash or flatten completely and not regain its original shape when the utensil is removed.

What does a level 6 diet consist of?: Suitable food options

Following a Level 6 diet involves selecting foods that are naturally soft or can be prepared to meet the necessary texture and size requirements. A wide variety of nourishing and enjoyable meals can be prepared within these guidelines.

Suitable Foods:

Protein: Cooked tender meat, poultry, or fish cut into bite-sized pieces (15mm for adults). Serving with a thick, smooth sauce or gravy adds moisture. Fish should have all bones removed. Eggs (scrambled, poached, or boiled and mashed) are also suitable.
Starches: Soft-cooked pasta or noodles, cut into small pieces and served with a thick sauce. Well-cooked rice can be used if it is not sticky and is served with a thick sauce that binds it together. Mashed potatoes or the soft flesh of baked potatoes are also good options.
Vegetables: Boiled, steamed, or roasted vegetables cooked until tender and cut into bite-sized pieces. Avoid fibrous, stringy, or tough vegetables.
Fruits: Soft, ripe fresh fruit (peeled and deseeded) or canned fruit in juice. Cut into small pieces or mash as needed. Avoid fruits with skins or fibrous parts.
Dairy and Desserts: Smooth, thick yogurts, custards, rice pudding, or mousse. Soft sponge cakes can be softened with cream or custard.
Cereals: Fully softened porridge or hot breakfast cereal. Ensure any milk has been fully absorbed, and no thin liquid remains.

Foods to Avoid:

Hard, tough, and chewy textures: Hard biscuits, flaky pastry, nuts, seeds, bone, or gristle.
Fibrous or stringy textures: Pineapple, celery, runner beans.
Crumbly foods: Dry toast, bread crusts, or crumble toppings.
Foods with husks or skins: Corn, grapes, peas, broad beans.
Sticky or gluey foods: Cheesy chunks or marshmallows.
Mixed Consistencies: Soups with watery broth but large vegetable pieces or fruit with separating juice (like watermelon).

Nutritional Considerations and Hydration on a Level 6 Diet

Maintaining adequate nutrition is a significant challenge for individuals on texture-modified diets, especially if appetite is poor. Food fortification is a common strategy to boost nutritional intake. Tips include:

Using full-fat milk, cream, or yogurt instead of low-fat options.
Adding butter, margarine, or cream to mashed potatoes and vegetables.
Sprinkling grated cheese into soups, sauces, and dishes.
Stirring sugar, honey, or jam into cereals and desserts.

Fluid intake is equally important. While food is modified, liquids are handled separately within the IDDSI framework (Levels 0-4). A speech pathologist may recommend thickened fluids to manage thin liquids, which can be a choking risk. Consistent hydration is essential for overall health.

Comparison: IDDSI Level 6 vs. Other Textures


Feature	Level 5: Minced & Moist	Level 6: Soft & Bite-Sized	Level 7: Regular Easy to Chew
Chewing Required	Minimal chewing required; soft, small lumps.	Moderate chewing required; tender, bite-sized pieces.	Biting and some chewing required; regular food but easy to chew.
Particle Size	Adult: Lumps no larger than 4mm.	Adult: Pieces no larger than 15mm x 15mm.	Normal, unrestricted food piece sizes.
Appearance	Cohesive, moist food with visible lumps.	Soft, tender, and moist foods, cut into safe bite-sized pieces.	Foods of a regular texture, though may be naturally easy to chew.
Fork Test	Lumps easily mashed with minimal fork pressure.	Mashing with fork flattens the food sample; does not return to shape.	Not applicable to test for softness.
Required Tool	Can be eaten with a fork or spoon; minimal chewing.	Can be eaten with a fork, spoon, or chopsticks.	Normal cutlery used.

Conclusion: Prioritizing Safety and Enjoyment

Adopting a Level 6 diet can significantly improve the safety and comfort of eating for individuals with mild dysphagia or other chewing challenges. By following the IDDSI standards for texture and particle size, caregivers and individuals can confidently prepare meals that reduce the risk of choking and aspiration. Though the modifications require careful attention, they do not need to compromise on taste or nutrition. Consistent monitoring by a speech pathologist and dietitian is essential to ensure the diet remains appropriate and nutritionally complete, leading to enhanced mealtime satisfaction and overall well-being. For further information and resources on the IDDSI framework, visit their official website.

Frequently Asked Questions

Regular bread is generally not recommended due to its potential to be dry and crumbly, posing a choking risk. However, plain bread that is finely chopped and softened by soaking in sauces or soup may be acceptable, but this should be discussed with a speech pathologist.

The fork pressure test is a method used to check if food meets the Level 6 criteria for softness. You press a sample of the food with the side of a fork; it should flatten and change shape easily, without returning to its original shape.

This diet is typically prescribed by a healthcare professional for individuals who have limited ability to bite and chew due to issues like mild dysphagia, missing teeth, or chewing-related pain or fatigue.

No, raw vegetables are generally too firm and tough for a Level 6 diet. Vegetables must be cooked (boiled or steamed) until tender and soft enough to be mashed easily with a fork.

The consistency of drinks is classified separately by IDDSI (Levels 0-4). Thin liquids like water can be dangerous for those with dysphagia and may need to be thickened, as advised by a speech pathologist.

For adults, a good visual guide is to ensure food pieces are no larger than the width of a standard dinner fork's tines. The maximum size is 15mm x 15mm.

If you have a small appetite, consider food fortification, such as adding full-fat dairy products like cream and cheese to meals to boost calorie and nutrient intake. It is important to consult a dietitian for advice.