What is the International Dysphagia Diet Standardisation Initiative (IDDSI)?
The International Dysphagia Diet Standardisation Initiative (IDDSI) is a globally recognised framework developed to create a common language for describing food texture and drink thickness for people with swallowing difficulties (dysphagia). By providing standardised descriptions and testing methods, IDDSI helps healthcare professionals, including dietitians and speech and language therapists (SLTs), and caregivers ensure that food is prepared and served at the correct consistency, reducing the risk of choking and aspiration.
The Shift to IDDSI in Ireland
Prior to 2019, various national and local standards existed across Ireland and the UK for describing modified food textures. However, the lack of uniformity could lead to confusion and patient safety risks. The adoption of the IDDSI framework in Ireland has provided a single, clear set of standards. The previous 'Texture A Soft' diet has been replaced by the IDDSI Level 6: Soft & Bite-Sized diet.
What Defines the Level 6 Soft & Bite-Sized Diet?
The IDDSI Level 6 diet is specifically designed for adults who can chew but may have difficulty biting off larger pieces of food or experience pain or fatigue while chewing. The key characteristics of this diet ensure that food is safe and manageable for these individuals while promoting better nutritional intake and meal enjoyment.
Characteristics of a Level 6 Diet
A food item must meet several criteria to be considered Level 6 compliant for adults:
- Soft, tender, and moist: All food items must be soft and tender throughout, with no separate thin liquid leaking from the food.
- Bite-sized pieces: For adults, food is cut into pieces no larger than 1.5 cm x 1.5 cm, approximately the width of a standard dinner fork or a thumbnail. This eliminates the need for the individual to bite off larger chunks.
- Easily mashed: The food should be soft enough to be easily mashed or broken down with pressure from a fork or spoon.
- Chewing is required: While the food is soft, it does require some chewing before it can be safely swallowed.
- No hard, crunchy, or stringy bits: Food must be free from any tough, fibrous, or hard pieces that could pose a choking risk.
How to Test a Level 6 Food
Two simple tests can be performed to ensure a food item meets the Level 6 criteria:
- Fork Pressure Test: Place a sample of the food on a plate. Press down with a fork until the thumbnail on your pressing finger turns white. The food should be completely squashed and not return to its original shape when the pressure is released.
- Size Check: Compare the size of the food pieces to the prongs of a standard fork. The pieces should be no wider than the fork's tines.
A Comparison of IDDSI Levels 5, 6, and 7
Understanding where the Level 6 diet sits within the IDDSI framework can provide valuable context. Here is a brief comparison of some related food texture levels for adults:
| Feature | IDDSI Level 5: Minced & Moist | IDDSI Level 6: Soft & Bite-Sized | IDDSI Level 7: Regular Easy to Chew |
|---|---|---|---|
| Texture | Soft and moist, but lumps are no bigger than 4mm. | Soft, tender, and moist. Food is in distinct, bite-sized pieces. | Normal, everyday foods, but soft and tender. |
| Particle Size | Max 4mm lump size for adults, which can be easily mashed with light fork pressure. | Max 1.5cm x 1.5cm pieces for adults, which require moderate chewing. | No restrictions on food piece size. |
| Chewing Required? | Only minimal chewing is needed. | Moderate amount of chewing is required. | Some chewing is required, but without tiring easily. |
| Preparation | Often achieved by mincing or processing foods and mixing with a thick sauce. | Cutting food into bite-sized pieces, ensuring they are tender and moist. | Involves selecting naturally soft or tender foods. |
Practical Tips for Preparing a Level 6 Diet
Preparing meals that are both safe and appealing on a Level 6 diet involves a combination of cooking techniques and smart ingredient choices.
- Proteins: Choose slow-cooked, tender meats (e.g., casseroles, stews) or flaky fish, and chop into 1.5cm pieces. Eggs (scrambled, poached) and skinless sausages also work well. Moisten with gravy or sauces.
- Carbohydrates: Mashed potatoes, well-cooked pasta served in a thick sauce, and soft-cooked rice that binds together are excellent choices. Some plain breads may be suitable if soaked in soup or sauce, but always check with an SLT first.
- Fruits and Vegetables: Cook vegetables until very soft and chop them into the appropriate size. Soft fruits like bananas, ripe mango, or tinned peaches (drained of excess juice) are ideal. Remember to remove skins, pips, and seeds.
- Dairy: Grated cheese, smooth yoghurts, and creamy sauces can add flavour and moisture.
Nutritional Fortification
For individuals with a small appetite or at risk of weight loss, fortifying meals is crucial. This can be achieved by adding nutritious extras like:
- Full-fat dairy products.
- Nutritional supplement powders.
- Extra butter, cream, or cheese to dishes.
Conclusion: Prioritising Safety and Enjoyment
The Level 6 diet, or Soft & Bite-Sized diet, is a critical tool within the IDDSI framework in Ireland for managing dysphagia and related chewing difficulties. By following the clear guidelines for food texture, moisture, and particle size, caregivers and individuals can significantly reduce the risk of choking and aspiration. This standardised approach ensures that patients can enjoy a variety of foods safely, promoting adequate nutrition and enhancing their overall quality of life. Always consult with a healthcare professional, such as a dietitian or speech and language therapist, for a personalised dietary plan.
