Understanding the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global framework for classifying food textures and liquid thickness to improve safety for people with dysphagia, or swallowing difficulties. The framework uses a numbered and color-coded system, with Level 6 (Soft & Bite-Sized) and Level 7 (Easy to Chew) representing the higher-level food textures, which require some chewing ability. Understanding the specific criteria for each level is crucial for preventing choking and aspiration.
What is a Level 6 Diet? Soft & Bite-Sized (Blue)
A Level 6 diet is designed for individuals who can safely chew and swallow, but are unable to bite off pieces of firm food. It is characterized by soft, moist, and tender foods that require a moderate amount of chewing. The food particles must be a specific size to reduce the risk of choking. This diet is often prescribed for people with weak oral muscles, poor dentition, or fatigue when chewing.
Key characteristics of a Level 6 diet:
- Size: All food pieces must be no larger than 1.5 cm x 1.5 cm for adults, approximately the width of a standard dinner fork.
- Softness: The food must be tender and moist. It should be easily cut or broken apart with the side of a fork. The IDDSI Fork Pressure Test, where a fork is pressed against the food until the thumbnail blanches, is used to confirm the texture. The food should flatten and not regain its original shape.
- Moisture: Foods must be moist throughout with no separate thin liquid. Sauces and gravies are used to bind and moisten the food.
Examples of Level 6 food:
- Finely chopped, tender cooked meats and fish with gravy
- Soft, cooked vegetables like carrots or potatoes, cut to the correct size
- Ripe, soft fruits without skin or seeds, such as banana or canned peaches
- Well-moistened breakfast cereals or porridge with milk
- Tender, well-cooked pasta in a thick sauce
What is a Level 7 Diet? Regular & Easy to Chew (Black)
Level 7 includes two sub-categories: Level 7 Regular and Level 7 Easy to Chew. The Easy to Chew sub-category is for individuals who can manage regular food but need a softer texture because they tire easily or have dental issues. It does not have size restrictions, but requires a functional chewing ability. The regular category covers all food textures for individuals with no chewing or swallowing difficulties.
Key characteristics of a Level 7 Easy to Chew diet:
- Size: Food pieces can be a range of sizes, as there are no restrictions. Individuals should be able to take a bite and chew effectively.
- Softness: Foods are soft and tender, easily broken apart with the side of a fork or spoon. They should not be hard, tough, or chewy.
- Chewing Ability: This diet requires adequate chewing strength and the ability to move food around the mouth without tiring.
Examples of Level 7 Easy to Chew food:
- Tender cooked meats, fish, and poultry that flake easily
- Cooked, tender vegetables and soft fruits, including watermelon, if the liquid is managed
- Soft bread with non-chewy fillings
- All breakfast cereals, provided they are not dry or hard
Comparison Table: Level 6 vs. Level 7
| Feature | Level 6: Soft & Bite-Sized | Level 7: Easy to Chew |
|---|---|---|
| Food Texture | Soft, tender, and moist throughout. | Normal, everyday foods, but must be soft and tender. |
| Particle Size | Strict size limit: no larger than 1.5 cm for adults. | No size restriction; person controls bite size. |
| Chewing Required | Moderate chewing required. | Strong chewing ability, but for soft textures. |
| Fork Test | Food must be easily cut with a fork and flatten under pressure. | Food must be easily cut or broken apart with a fork. |
| Risk Level | Designed to reduce choking risk by managing particle size. | Not for those with an identified choking risk. |
| Primary Goal | To provide nutrition safely for those with reduced chewing ability. | To accommodate weaker chewing muscles while eating regular foods. |
Transitioning Between Diet Levels
Transitioning between diet levels should always be guided by a healthcare professional, such as a Speech-Language Pathologist or a dietitian. They will assess the individual's chewing and swallowing function to determine if they can progress safely. Moving from a Level 6 to a Level 7 diet involves removing the size restriction and introducing a wider variety of soft-textured foods. Close monitoring is essential during this period to ensure the person can manage the new textures without tiring or showing signs of difficulty.
How to Prepare Foods for Level 6 and 7
Food preparation for Level 6:
- Cut and chop: Ensure all food is chopped into pieces no larger than 1.5 cm x 1.5 cm. A special tool or template can help standardize the size.
- Tenderize: Cook meats, vegetables, and other tough foods until very tender. Use methods like slow-cooking, steaming, or boiling.
- Moisten: Use sauces, gravies, and soups to add moisture. Avoid serving food with separate thin liquids.
- Remove tough parts: Always remove skins, bones, gristle, seeds, and fibrous parts of fruits and vegetables.
Food preparation for Level 7 (Easy to Chew):
- Choose tender foods: Select naturally soft and tender foods like flakey fish, well-cooked chicken, or soft-cooked vegetables.
- Avoid certain textures: Steer clear of hard, tough, chewy, fibrous, or crunchy foods. This includes things like hard nuts, tough steak, and raw vegetables.
- Test for softness: Use the fork pressure test to confirm that food can be easily broken apart with the side of a fork or spoon before serving.
Conclusion: Prioritizing Safety and Enjoyment
In conclusion, understanding what is a Level 6 and 7 diet is essential for providing safe and nutritious meals for individuals with chewing and swallowing challenges. The IDDSI framework offers clear, standardized guidelines that help ensure patient safety while maximizing their mealtime enjoyment. By adhering to the specific preparation and testing methods, caregivers can confidently provide appropriate meals. For anyone on a modified diet, it is always recommended to work closely with a healthcare professional to ensure the correct diet texture is prescribed and monitored for safety and nutritional adequacy. For comprehensive guidelines, refer to the official IDDSI website.
Lists of Appropriate and Avoided Foods
Level 6: Soft & Bite-Sized
Appropriate Foods:
- Moist casseroles with chopped meat
- Soft, cooked pasta in a thick sauce
- Steamed fish with a cream sauce
- Well-cooked, diced vegetables
- Bananas, ripe melons, and other soft fruits without skin
Foods to Avoid:
- Hard, dry foods like crackers or nuts
- Crumbly textures like dry cake or pastry
- Chewy items such as marshmallows or tough meats
- Foods with skins, seeds, or bones
Level 7: Easy to Chew
Appropriate Foods:
- Tender roasted chicken or turkey
- Baked or steamed flakey fish
- Soft-cooked stews with vegetables
- Soft pasta dishes
- Pancakes with syrup
Foods to Avoid:
- Tough or dry meats like jerky or steak
- Crunchy or crispy foods like raw carrots or popcorn
- Fibrous or stringy items like pineapple or celery
- Hard-to-chew sweets or candies
Key Takeaways
- Level 6 is for moderate chewing: Individuals on this diet can chew but need soft, moist, and pre-cut, bite-sized pieces to minimize choking risk.
- Level 7 is for easy chewing: This diet accommodates those who need softer textures due to weaker chewing muscles or dental issues, but can manage normal food sizes.
- Standardized safety is paramount: The IDDSI framework provides clear guidelines and testing methods to ensure consistency and patient safety across all care settings.
- Food size is the main differentiator: The strict 1.5 cm particle size limit for Level 6 is the primary distinction from Level 7, which has no size restrictions.
- Professional guidance is key: Any transition between diet levels should be supervised by a healthcare professional, such as a Speech-Language Pathologist, to ensure safety and appropriateness.
- Proper preparation is crucial: Modifying texture involves more than just cutting food; it requires removing tough parts and ensuring adequate moisture for safe swallowing.
- Focus on food quality: Even with texture modifications, a modified diet should not compromise nutrition or enjoyment. Full-fat dairy or sauces can add extra calories and flavor.
FAQs
What is the main difference between a Level 6 and Level 7 diet? The main difference is particle size and chewing ability. Level 6 requires all food to be soft and cut into specific, small sizes (1.5 cm), while Level 7 allows normal, soft-textured foods of any size, as long as they can be easily chewed.
Who typically needs a Level 6 diet? A Level 6 diet is for people who can chew but have difficulty managing tough textures or biting off pieces of firm food. This includes individuals with poor dentition, weak oral muscles, or fatigue.
Can someone on a Level 7 Easy to Chew diet eat regular food? Yes, the Level 7 Easy to Chew diet consists of normal, everyday foods, but they must be naturally soft or cooked until tender. It avoids hard, tough, or chewy textures.
How can I test food to ensure it is Level 6 compliant? Use the IDDSI Fork Pressure Test. Press down on a food piece with a fork until your thumbnail blanches. If the food mashes completely and doesn't return to its original shape, it is soft enough for Level 6. Also, ensure the pieces are no larger than 1.5 cm.
Are all Level 7 diets the same? No. Level 7 has a 'Regular' category for people with no swallowing issues and an 'Easy to Chew' sub-category for those needing softer textures due to mild difficulties with chewing.
What if a person with a Level 6 diet doesn't chew their food well? If food isn't being chewed well, it can increase the risk of choking. It is important to consult a clinician to ensure the person is on the correct food texture level.
Do I need a doctor's recommendation for these diets? Yes, it is crucial to consult a healthcare professional, such as a Speech-Language Pathologist or dietitian, before changing a person's diet to ensure it is safe and appropriate for their specific needs.
Citations
IDDSI Level 6 & 7 Texture Standards for aged care food. Unilever Food Solutions. Retrieved October 14, 2025, from https://www.unileverfoodsolutions.com.au/chef-inspiration/aged-care-re-fresh/iddsi-resources/iddsi-level-6-and-7-texture-standards.html The IDDSI Standard. International Dysphagia Diet Standardisation Initiative. Retrieved October 14, 2025, from https://www.iddsi.org/standards/framework IDDSI Level 6: Soft and Bite-sized diet. Milton Keynes University Hospital. Retrieved October 14, 2025, from https://www.mkuh.nhs.uk/patient-information-leaflet/iddsi-level-6-soft-and-bite-sized-diet REGULAR EASY TO CHEW - IDDSI. International Dysphagia Diet Standardisation Initiative. Retrieved October 14, 2025, from https://www.iddsi.org/images/Publications-Resources/PatientHandouts/English/Adults/7_easy_to_chew_adult_consumer_handout_30jan2019.pdf Swallowing advice for a Regular Easy to Chew Diet (Level 7). Northern Care Alliance. Retrieved October 14, 2025, from https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/speech-and-language-therapy-swallowing-advice-regular-easy-chew-diet-level-7?q=%2Fpatient-information%2Fpatient-leaflets%2Fspeech-and-language-therapy-swallowing-advice-regular-easy-chew-diet-level-7
