Understanding the IDDSI Framework
In the past, medical facilities used inconsistent terminology like 'soft diet' to describe food textures, leading to confusion and potential safety risks for patients with swallowing difficulties. The International Dysphagia Diet Standardisation Initiative (IDDSI) was created to address this problem by providing a standardized, international framework for describing food and drink thickness. The IDDSI framework consists of a continuum of eight levels, from Level 0 (Thin liquids) to Level 7 (Regular food). Each level has specific criteria and testing methods to ensure consistency and patient safety, especially for individuals with dysphagia.
The two categories of a Level 7 diet
Within the IDDSI framework, the Level 7 category is divided into two sub-types to better meet patient needs: Level 7 Regular and Level 7 Regular Easy to Chew. The determination of which level is appropriate is made by a healthcare professional, such as a dietitian or speech and language therapist, based on a comprehensive assessment of the patient's chewing and swallowing abilities.
- Level 7 Regular: This is the standard, everyday diet with no texture or piece size restrictions. It is for individuals who have no problems with chewing or swallowing and are not at risk for choking.
- Level 7 Regular Easy to Chew (EC7): This is for individuals who have difficulty with hard or tough textures due to factors such as dental problems, jaw pain, fatigue, or recovery. The food is soft and tender, and while there are no restrictions on the size of food pieces, the patient must be able to regulate their own bite size.
Characteristics of a Level 7 Easy to Chew Diet (EC7)
The EC7 diet focuses on soft and tender food textures while excluding items that require a strong bite force or extended chewing. The characteristics are designed to make eating more comfortable and less tiring for patients who need it.
Key characteristics of the EC7 diet include:
- Soft and tender texture: Foods must be soft enough to break apart easily with the side of a fork or spoon.
- No specific piece size: Unlike lower-level diets, there are no restrictions on the size of food pieces. The patient is expected to be able to manage their own bite size.
- Moisture is key: Foods should be moist throughout, with no tough, dry, or crumbly parts.
- No chewing fatigue: The individual must be able to chew the soft, tender foods without tiring easily.
What foods are included and avoided?
To ensure patient safety and comfort, a Level 7 Easy to Chew diet specifies which foods are suitable and which must be avoided.
Foods to include on a Level 7 Easy to Chew Diet:
- Protein: Tender-cooked meats (e.g., casseroles, stews), soft fish, ground or finely minced meats, boneless fish, soft meatballs.
- Carbohydrates: Well-cooked pasta, soft noodles, mashed potatoes, baked potatoes (insides only), well-cooked rice.
- Vegetables: Softly boiled or steamed vegetables (e.g., carrots, parsnips, broccoli), mushy peas, sweet potatoes.
- Fruit: Soft fruits like bananas, ripe peaches, and pears. Tinned or stewed fruits with skins removed are also suitable.
- Dairy and Snacks: Yogurt, milk puddings, crème caramel, soft cake with custard, softened biscuits.
Foods to avoid on a Level 7 Easy to Chew Diet:
- Hard or Dry Foods: Nuts, raw vegetables, hard crackers, dry cakes, hard bread.
- Tough or Chewy Foods: Steak, chewy sweets, dried fruits, foods with gristle.
- Fibrous or Stringy Foods: Pineapple, beans, rhubarb.
- Crunchy or Crumbly Foods: Popcorn, crispy bacon, pie crust.
- Mixed Consistencies: Soups with solid lumps, watery cereal.
- Items with Seeds or Bones: Foods with pips, seeds, or bones.
Level 7 vs. Level 6: A comparison
It's important to understand the distinction between the different IDDSI diet levels to ensure the patient receives the correct texture modification. Here's a comparison between the Level 7 Regular Easy to Chew diet and the Level 6 Soft & Bite-Sized diet.
| Feature | Level 7: Regular Easy to Chew (EC7) | Level 6: Soft & Bite-Sized (SB6) |
|---|---|---|
| Chewing Ability | Requires the ability to chew soft and tender foods without tiring easily. | Minimal chewing is required, often for individuals with dental problems or fatigue. |
| Particle Size | No restriction on particle size. The individual bites and chews at their own pace. | Foods must be soft and cut into bite-sized pieces (adult size: max 1.5 cm). |
| Testing Method | Foods break apart easily when pressed with the side of a fork. | Foods must be soft enough to be cut with the side of a fork and pass the 'Fork Pressure Test'. |
| Preparation | Foods are cooked until tender and moist. | Foods are cooked until tender and often cut into small, consistent pieces. |
| Supervision | Generally does not require supervision for eating, but not suitable for those with significant choking risk. | May be prescribed for individuals with an increased choking risk, potentially requiring supervision. |
The importance of a level 7 diet in a hospital setting
Prescribing the correct texture-modified diet is a critical aspect of patient care in a hospital. For patients transitioning from more restrictive diets, or for those with underlying conditions that make chewing difficult, a Level 7 Easy to Chew diet provides several key benefits:
- Ensures nutritional intake: A comfortable and safe diet encourages patients to eat more, preventing malnutrition and dehydration during recovery.
- Reduces choking risk: By eliminating hard, tough, or sticky foods, the risk of choking is minimized for vulnerable patients.
- Promotes safe swallowing: This diet helps patients exercise and improve their chewing abilities gradually, which is a step towards a regular diet.
- Increases mealtime enjoyment: For patients who struggle with harder food, a tender, moist diet can make mealtimes a more pleasant and dignified experience.
How to prepare food for a Level 7 Easy to Chew consistency
Preparing food for an EC7 diet focuses on tenderness and moisture. Meats should be slow-cooked, stewed, or finely minced and served with gravy or sauce. Vegetables should be boiled or steamed until very soft. Excess liquid from fruits or cereals should be drained to avoid dual consistencies. A simple Fork Pressure Test can be used to check if the food is soft enough by pressing down on it with the side of a fork; it should squash completely and not regain its original shape.
Transitioning from a level 7 diet
In many cases, the Level 7 Easy to Chew diet is a temporary step towards a full, regular diet. As a patient's chewing strength and overall health improve, a speech and language therapist or dietitian will assess their progress. If the patient can manage more challenging textures without fatigue, they may be cleared for the standard Level 7 Regular diet, which includes all food textures and sizes.
Conclusion
For many patients in a hospital setting, understanding what is a level 7 diet in hospital is key to their nutritional health and safety. The IDDSI framework provides clear, standardized guidelines for the Level 7 Easy to Chew diet, which prioritizes soft, tender, and moist foods to accommodate chewing difficulties without posing a choking risk. This approach not only ensures a safe eating experience but also helps promote recovery by preventing malnutrition and dehydration. Following the recommendations of a healthcare professional is paramount for the best outcomes during this nutritional transition. For further information, the IDDSI website provides comprehensive resources.
