What foods should you avoid on IDDSI level 6?

January 5, 2026 •

3 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), millions of people worldwide require modified diets to manage swallowing difficulties safely. For those on IDDSI Level 6, understanding the specific food restrictions is crucial for preventing choking and aspiration.

Quick Summary

A comprehensive guide to unsafe foods for the IDDSI level 6 diet. This article outlines hard, chewy, sticky, and mixed consistency items that pose a choking risk and must be avoided.

Key Points

Avoid Tough Textures: Stay away from hard, chewy, or tough foods like steak and raw vegetables that are difficult to chew and swallow safely.
Eliminate Dual Consistencies: Foods containing both thin liquid and solid chunks, such as soup with loose vegetables, are highly unsafe and should be avoided.
Prohibit Sticky Foods: Do not serve sticky items like nut butter, toffees, or marshmallows, as they can adhere to the mouth and throat.
Remove All Hard Parts: Before serving, remove all skins, seeds, pips, bones, and gristle from food.
Cut to Correct Size: Ensure all food pieces are soft and no larger than 1.5 cm x 1.5 cm for adults to minimize choking risk.
Test for Softness: Always perform the IDDSI fork pressure test to confirm that a food can be easily mashed and is safe for consumption.
Be Mindful of Temperature: Foods like ice cream and jelly can change consistency at different temperatures and may be unsafe if they become too thin.

Understanding the IDDSI Level 6 Diet

IDDSI Level 6, also known as the Soft & Bite-Sized diet, is designed for individuals who have difficulty chewing and swallowing but can safely manage soft, moist foods cut into small, manageable pieces. These foods require some chewing but must be easily mashed or broken down by a fork. The primary goal is to reduce the risk of choking and aspiration (when food or liquid enters the lungs) by controlling food texture and particle size.

This diet requires that all foods are soft, tender, and moist throughout, with no separate thin liquid. The particle size for adults is typically restricted to no larger than 1.5cm x 1.5cm (about the size of a thumbnail), while for children it is 8mm. This strict control over texture and size means many common foods must be excluded from the diet to ensure safety.

Key Categories of Foods to Avoid

Hard, Tough, and Chewy Foods

Foods with tough or hard textures are extremely dangerous for someone on a Level 6 diet because they cannot be broken down sufficiently in the mouth. The person may lack the chewing strength or oral motor control to prepare a safe-to-swallow bolus.

Tough cuts of meat (e.g., steak, pork chops)
Hard, raw vegetables (e.g., carrots, broccoli, celery)
Nuts, seeds, and popcorn
Hard and chewy sweets (e.g., toffee, chewing gum)
Dry, crumbly foods (e.g., dry cake, biscuits, crackers)

Mixed Consistency Foods

One of the most significant risks for individuals with dysphagia is food with mixed consistencies. This refers to foods where a solid component is in a thin liquid, as the liquid can be swallowed before the solid, increasing the risk of aspiration.

Cereal in milk that does not absorb all the liquid
Minced meat in thin gravy or sauce
Soups with chunky vegetables or pieces of meat
Juicy fruits where the liquid separates from the pulp, such as watermelon or oranges
Ice cream and jelly (for those on thickened fluids, as these melt into a thin consistency)

Sticky and Fibrous Textures

Sticky and stringy foods can adhere to the mouth or throat, becoming difficult to clear and posing a choking hazard. Fibrous materials cannot be adequately broken down and can form clumps.

Nut butter or sticky caramel
Marshmallows or chewy sweets
Overcooked or glutinous rice
Stringy vegetables (e.g., celery, runner beans, pineapple)
Cheese that melts into stringy strands

Foods with Skins, Seeds, Pips, Bones, or Gristle

Any food item that contains non-softening components like skins, seeds, or gristle must be completely avoided or meticulously prepared by removing the problematic parts.

Grapes, peas, baked beans, sweetcorn (all have skins or husks)
Berries with small pips or seeds
Bread containing seeds or grains
Meat or fish with bones or gristle
Sausages with skins (unless removed)

Comparison of Unsafe vs. Safe Food Options for IDDSI Level 6


Food Type	Unsafe Examples (Avoid)	Safe Examples (Prepare)
Protein	Steak, crispy fried fish, chicken with gristle	Cooked tender minced meat in thick gravy, soft fish flakes, omelette
Vegetables	Raw carrots, celery, stir-fried vegetables, peas	Well-cooked, soft boiled or steamed vegetables cut to 1.5cm, creamed sweetcorn, mashed potato
Fruit	Grapes, apples, oranges, watermelon, dried fruit	Soft, ripe banana, avocado, canned peaches (drained, no skin), stewed apples (no skin)
Grains	Dry toast, crusty bread, sticky rice, dry cereal	Fully moistened porridge, plain sponge cake with custard, pasta in thick sauce
Sweets/Desserts	Hard candy, sticky caramel, nuts, marshmallows	Smooth custard, yogurt (without bits), milk puddings, soft sponge cake with cream
Soups	Broth with chunky vegetables, noodle soups	Thick, creamy soup (blended until smooth, or with soft, small pieces)

Conclusion: Prioritizing Safety and Texture

For individuals on an IDDSI Level 6 diet, food safety hinges on strict adherence to texture and size guidelines. While the restrictions may seem extensive, they are necessary to prevent serious health risks associated with swallowing difficulties. Always prioritize foods that are soft, moist, and cut to the appropriate size, and eliminate anything hard, chewy, sticky, or with mixed consistencies. When in doubt, perform the IDDSI fork pressure test to confirm that a food can be easily mashed. For personalized advice, always consult a healthcare professional like a speech and language therapist or dietitian. By following these precautions, it is possible to maintain a safe, nutritious, and varied diet. For more in-depth information, you can also explore the resources available on the official IDDSI website.

Frequently Asked Questions

Regular, dry, or crusty bread is generally avoided. Some plain white or wholemeal bread may be acceptable if it is finely chopped, fully soaked in a sauce or gravy, and approved by a speech and language therapist.

Yes, but only certain types. The fruit must be soft, ripe, and skinless, with any excess juice drained. It should be cut into the appropriate bite-sized pieces. Fibrous fruits, dried fruits, or those with seeds and pips must be avoided.

For individuals who have been advised to have thickened fluids, ice cream and jelly are often unsafe. This is because they can change consistency in the mouth, melting into a thin liquid and increasing the risk of aspiration.

A meat is too tough if it cannot be easily mashed or broken down with the pressure from a fork. It should be tender and moist. Tough or chewy cuts, or any meat with gristle or bones, should be completely avoided.

No, nuts, seeds, and pips are considered hard textures and are strictly prohibited on an IDDSI Level 6 diet to prevent choking. This includes seeds in bread or fruit.

Mixed consistency foods, such as cereal with un-absorbed milk or mince with thin gravy, are dangerous because the thin liquid can be swallowed too quickly, leaving the solid food behind. This increases the risk of choking and aspiration.

Eating foods that do not meet the Level 6 standard can lead to serious health complications. The risk of choking and aspiration is significantly increased, which can be life-threatening.

No, raw vegetables are typically not suitable for a Level 6 diet because they remain too hard and crunchy even when chopped. They must be cooked until soft and tender to be mashed easily with a fork.