The IDDSI framework was developed to provide a common, standardized terminology for describing food textures and drink thickness to improve safety for individuals with chewing and swallowing problems, known as dysphagia. The framework consists of a continuum from level 0 (thin liquids) to level 7 (regular foods). For each level, certain food properties become unsafe, meaning a deep understanding of what foods should people with iddsi avoid is vital for patient safety.
General Food Categories to Avoid for All IDDSI Levels
While specific exclusions differ by level, several types of food are generally unsafe for any individual on a modified texture diet. These items present a universal choking or aspiration risk due to their physical properties.
- Hard, Tough, and Crunchy Foods: This includes nuts, hard candy, tough meat, popcorn, crackers, and raw vegetables like carrots or celery. These are difficult or impossible to chew thoroughly and can present a severe choking hazard.
- Mixed Thin and Thick Textures: Food with both liquid and solid components, such as soup with vegetable chunks or cereal with milk, can be problematic because the thin liquid portion can be aspirated before the solid is fully managed.
- Fibrous or Stringy Foods: Items like pineapple, green beans, stringy cheese, and rhubarb can be difficult to chew down to a safe size.
- Sticky or Gummy Foods: Peanut butter, caramel, taffy, marshmallows, and dried fruits can adhere to the roof of the mouth or throat, posing a choking risk.
- Foods with Skins, Seeds, or Husks: The outer layers of items like peas, grapes, sausages, and corn kernels do not break down easily and can be a choking hazard.
Avoiding Food Based on Specific IDDSI Levels
Depending on the specific IDDSI level prescribed by a healthcare professional, the list of restricted foods can vary significantly. The following guidelines highlight foods to avoid at the most common food levels.
IDDSI Level 4 (Pureed)
For individuals on a pureed diet, chewing is not required, and the food should have a smooth texture with no lumps.
- Avoid Lumps: Any lumps, seeds, or skins are dangerous. The puree must be completely smooth and uniform.
- Avoid Dryness and Stickiness: The food must not be dry or sticky, as this can cause it to cling to the mouth and throat.
- Avoid Separating Liquids: The food and any accompanying liquid, like a sauce, must not separate.
IDDSI Level 5 (Minced and Moist)
This level allows for small, soft, and moist pieces of food, but biting is not necessary. Pieces should be no larger than 4mm.
- Avoid Hard or Crunchy Bits: Any hard textures, such as uncooked vegetables, tough meat, nuts, or seeds, are prohibited.
- Avoid Separate Thin Liquid: The food must remain moist, with no excess thin liquid separating from the minced solid portion.
- Avoid Stringy or Chewy Textures: Meat with gristle, pineapple, or sticky foods should not be served.
IDDSI Level 6 (Soft and Bite-Sized)
At this level, individuals can chew soft, bite-sized pieces, but they cannot bite off pieces from a larger item. Pieces for adults should be no larger than 1.5 cm.
- Avoid Tough or Hard Foods: Tough meats, crusts from bread or pies, and fibrous vegetables like raw carrots are not suitable.
- Avoid Crispy or Crunchy Textures: Crackling, crisp bacon, and crispy cereal flakes are unsafe.
- Avoid Mixed Textures: As with lower levels, mixed consistencies like mince in thin gravy are risky.
Comparison of Food Restrictions by IDDSI Level
| Food Characteristic | Level 4 (Pureed) | Level 5 (Minced & Moist) | Level 6 (Soft & Bite-Sized) |
|---|---|---|---|
| Hard/Crunchy Foods | Absolutely avoid (e.g., nuts, crackers). | Avoid all hard textures. | Avoid tough, hard, and crispy items (e.g., tough bacon). |
| Mixed Consistencies | Avoid (e.g., soup with bits). | Avoid (e.g., cereal in milk). | Avoid (e.g., mince in thin gravy). |
| Skins, Seeds, Husks | Avoid entirely (e.g., pea skins, seeds). | Avoid completely (e.g., corn, grape skins). | Avoid (e.g., fruit skins, seeds). |
| Sticky/Gummy Foods | Avoid (e.g., peanut butter). | Avoid (e.g., sticky rice, caramel). | Avoid (e.g., caramel candy). |
| Stringy/Fibrous Foods | Avoid entirely (e.g., pineapple). | Avoid (e.g., rhubarb, green beans). | Avoid (e.g., pineapple, celery). |
| Lumps | Avoid all lumps. | Lumps restricted to 4mm or less. | Lumps restricted to 1.5cm or less. |
Final Advice and Outbound Link
Managing a modified diet requires careful attention to detail. Always prepare and test food textures according to the specific IDDSI guidelines prescribed by a healthcare professional. Serving the incorrect food texture can have severe consequences, including choking and aspiration. Beyond food preparation, it's also important to practice safe eating habits, such as sitting upright and focusing on chewing. For comprehensive information and resources on the official framework and testing methods, consult the official IDDSI website. This site provides valuable tools and detailed guidance for safe eating and drinking management.
Conclusion
For individuals with dysphagia, a complete understanding of what foods should people with iddsi avoid is fundamental for safety and quality of life. The general rule of thumb is to steer clear of hard, sticky, stringy, and mixed-texture foods, but specific restrictions vary considerably across the different IDDSI levels. Adherence to the prescribed texture, regular food testing, and cautious preparation are essential practices. By following these guidelines, caretakers and individuals can minimize risks and ensure a safe and nourishing diet is maintained.
