What is a SB6 diet? Understanding the Soft and Bite-Sized Food Level

October 5, 2025 •

5 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), the SB6 diet is a specific texture-modified diet designed to minimize the risk of choking and aspiration. But what is a SB6 diet, and who is it prescribed for? It provides foods that are soft, tender, and moist, all cut into safe, manageable, bite-sized pieces for individuals experiencing chewing or swallowing problems.

Quick Summary

The Soft and Bite-Sized (SB6) diet is a therapeutic, texture-modified eating plan under IDDSI Level 6 for individuals with chewing or swallowing impairments. It consists of soft, tender, moist foods cut into precise, small pieces to be easily managed in the mouth. It is used to ensure safe swallowing and adequate nutrition.

Key Points

Therapeutic Purpose: The SB6 diet is a medically prescribed, texture-modified diet for people with chewing and swallowing issues (dysphagia).
IDDSI Framework: It corresponds to Level 6 of the International Dysphagia Diet Standardisation Initiative (IDDSI), a global standard for modified foods.
Texture and Size: Foods must be soft, tender, and moist, and cut into specific bite-sized pieces (1.5cm for adults) to minimize choking risk.
Chewing Required: This diet is suitable for individuals with some chewing ability who cannot safely manage larger, harder food pieces.
Moisture is Key: Foods must be moist throughout with no thin liquid separating, requiring the use of thick sauces, gravies, or gravies.
Safety First: The diet should be supervised by healthcare professionals like a speech-language pathologist or dietitian to ensure proper implementation and nutrition.
Nutritional Focus: It is crucial to fortify meals with extra calories and protein to prevent malnutrition, as intake can be lower on modified diets.

What is a SB6 diet?

The SB6 diet, or Soft and Bite-Sized diet, is a texture-modified eating plan corresponding to Level 6 of the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. It is not a weight-loss or fad diet, but a medically prescribed nutritional strategy for individuals with dysphagia, or difficulty swallowing. The core principle is modifying food so that it is soft, moist, and cut into small, consistent pieces, typically no larger than 1.5cm by 1.5cm for adults, and even smaller for children. This significantly reduces the effort required to chew and move food in the mouth, minimizing the risk of choking and aspiration pneumonia.

Who needs the Soft and Bite-Sized (SB6) diet?

A healthcare provider, such as a speech-language pathologist or dietitian, may prescribe the SB6 diet for people with conditions that impair their ability to bite and chew safely. This can include:

Individuals with mild dysphagia who can chew but cannot safely bite off large pieces of food.
People with poorly fitting dentures, missing teeth, or mouth pain.
Those who experience fatigue while chewing due to a medical condition.
Patients recovering from certain medical procedures or strokes.

The SB6 diet is designed for people who can manage moderate chewing but require the food to be pre-processed into a safe size and consistency. It is a transitional diet, as some individuals may progress to a less restrictive texture as their condition improves.

Characteristics of SB6 foods

Food for the SB6 diet must meet several specific criteria, which can be checked using simple testing methods:

Soft and Tender: The food should be soft enough to be mashed easily with a fork or spoon, without regaining its original shape once pressure is removed. The pressure on the fork should cause the food to flatten significantly, turning the tester's thumbnail white.
Bite-Sized Pieces: For adults, food pieces must be no larger than 1.5cm x 1.5cm. This is approximately the width of a standard dinner fork.
Moist: All foods must be moist throughout, often with gravy, sauce, or custard to prevent them from becoming dry or crumbly. There should be no separate thin liquids that could drain away, as this presents a choking risk.
Non-sticky: The food should not be sticky or gluey, as this can make it difficult to swallow.

Preparing food for the SB6 diet

Food preparation for the SB6 diet focuses on achieving the correct texture and size. Here are some examples of suitable foods and preparation techniques:

Suitable Proteins:

Slow-cooked, tender meats like casseroles, stews, or ground meat served with a thick, smooth gravy.
Flaked fish, with all bones removed, served with a creamy sauce.
Finely chopped tender poultry.
Scrambled, poached, or soft-boiled eggs.
Soft legumes like well-cooked baked beans.
Tofu cut into small pieces.

Suitable Fruits and Vegetables:

Well-cooked and chopped vegetables like carrots, cauliflower, or sweet potato.
Soft fruits like ripe bananas, avocado, or tinned peaches, chopped into small pieces.
Stewed fruit with no skins or pips.

Suitable Grains and Starches:

Moistened cereals, such as porridge or soaked wheat biscuits.
Pasta dishes like macaroni and cheese or lasagna, with the pasta cooked soft and served with plenty of sauce.
Soft mashed potatoes or risotto served with a thick sauce.
Soft sponge cakes or wafer biscuits.

Comparison of IDDSI Diet Levels

To understand where the SB6 diet fits, it is helpful to compare it with other IDDSI texture levels. This table highlights key differences in consistency and chewing requirements.


Feature	Level 5 (Minced & Moist)	Level 6 (Soft & Bite-Sized)	Level 7 (Regular)
Chewing Required	Minimal; mostly tongue-palate pressure	Moderate; able to chew soft, tender pieces	Normal; able to chew a variety of foods
Food Particle Size	Small, soft, minced lumps (≤ 4mm)	Bite-sized, tender pieces (≤ 1.5cm for adults)	All sizes, as in a typical diet
Moisture Content	Must be moist, cohesive, and hold its shape	Must be moist, tender, no thin liquid separation	Regular moisture, can include thin liquids
Fork Test	Spreads easily, with minimal force	Breaks and squashes easily with fork pressure	Resists breaking with fork pressure
Purpose	For severe chewing problems or difficulty managing mixed textures	For moderate chewing difficulties, poor dentition, or limited biting ability	For those with no chewing or swallowing difficulties

Ensuring nutritional adequacy on the SB6 diet

Since the SB6 diet restricts certain food types and may lead to reduced intake, it is important to take steps to ensure nutritional needs are met. Many patients on modified diets are at risk of weight loss and malnutrition.

Choose Nutrient-Dense Foods: Use full-fat products like whole milk, cream, and full-fat yogurt to increase calorie and protein intake.
Fortify Meals: Add ingredients like skim milk powder, melted cheese, or cream cheese to sauces, mashed potatoes, and cereals to boost calories and protein without increasing volume.
Add Sauces and Gravies: Use plenty of thick, creamy sauces, gravies, and dressings to keep food moist and increase calorie content.
Incorporate Healthy Snacks: Offer nutritious snacks between meals, such as milky drinks, puddings, or soft fruit with cream or yogurt.
Maintain Hydration: Ensure regular fluid intake throughout the day. While some liquids may need to be thickened, it's vital to stay hydrated.

Authoritative medical guidance

Because the SB6 diet is a therapeutic eating plan, it should only be followed under the supervision of a registered dietitian or speech-language pathologist. These professionals will monitor your specific needs and can adjust the diet as appropriate. The International Dysphagia Diet Standardisation Initiative provides the global framework for these diets, ensuring a consistent and safe standard of care. You can find detailed information about the IDDSI framework and testing methods by visiting their website: IDDSI.org.

Conclusion

The SB6 diet, or Soft and Bite-Sized diet, is a critical nutritional tool for individuals with chewing or swallowing difficulties. By adhering to precise standards for food size, texture, and moisture, it significantly enhances patient safety and comfort during meals. While its primary purpose is therapeutic rather than for general wellness or weight management, ensuring the nutritional density of meals is essential for those who rely on it. Working closely with healthcare professionals is key to implementing the SB6 diet successfully and safely.

Frequently Asked Questions

Suitable meats include slow-cooked, tender meat from stews or casseroles, and finely chopped or ground meat served in a thick, smooth gravy or sauce. Fish should be flaked and served with a sauce, with all bones completely removed.

Well-cooked, soft vegetables that can be easily mashed with a fork are suitable. Examples include boiled or steamed carrots, sweet potatoes, and cauliflower. Vegetables should be chopped into bite-sized pieces before serving.

Yes, but they must be well-cooked and served with a thick, smooth sauce to ensure they are moist and hold together. Rice should not separate into individual grains. Well-cooked pasta dishes like lasagna or macaroni and cheese are also suitable.

Perform the fork pressure test: press down on the food with a fork until your nail turns white. The food is soft enough if it squashes completely and does not return to its original shape. Additionally, ensure all pieces are cut to the appropriate size (1.5cm for adults).

Avoid foods that are dry, tough, crunchy, stringy, or crumbly. Examples include tough meats, raw vegetables, bread with crusts, dry crackers, nuts, seeds, and chewy or sticky items like caramel or chewing gum.

To increase nutritional intake, use full-fat dairy products, add skim milk powder to liquids, incorporate cream or cheese into dishes, and add butter or margarine generously. Nutrient-rich snacks like milky drinks and custards can also be added between meals.

The SB6 diet can be a long-term solution for some chronic conditions, but for others, it may be a temporary step. A speech-language pathologist will continuously monitor the patient’s swallowing ability and recommend a less restrictive diet if appropriate.