Understanding the IDDSI Stage 6 Diet
The 'Stage 6 diet' is formally known under the International Dysphagia Diet Standardisation Initiative (IDDSI) framework as the Soft and Bite-sized level. This is a clinically prescribed diet for individuals with dysphagia, or swallowing problems, who have the ability to chew but cannot safely bite off pieces of food from a larger portion. The primary goal is to provide a variety of foods in a texture and size that minimizes the risk of choking and aspiration (food or liquid entering the lungs). The framework uses a numbered scale (0-7), with Level 6 requiring a moderate amount of chewing.
Why a Stage 6 Diet is Prescribed
Speech and Language Therapists and dietitians may recommend a Soft and Bite-sized diet for several reasons related to a person's chewing and swallowing abilities.
- Difficulty biting or breaking apart regular-textured foods.
- Pain or fatigue during chewing.
- Problems collecting food into a cohesive ball (bolus) before swallowing.
- Individuals with poorly fitting dentures or missing teeth.
By controlling the size and tenderness of food, this diet allows individuals to continue enjoying a broader range of foods safely and maintain adequate nutritional intake.
Key Characteristics of Soft and Bite-Sized (Level 6) Foods
All foods on this diet must meet specific criteria to ensure safety.
- Soft and tender: Foods should be easily mashed or broken down with the pressure from a fork or spoon.
- Moist: Foods must be consistently moist, and no separate thin liquid (e.g., watery sauce) should leak from them.
- Bite-sized pieces: For adults, all pieces must be cut or prepared to a size no larger than 1.5 cm x 1.5 cm, approximately the width of a standard dinner fork. Pediatric sizes are smaller, at 8mm.
- Non-sticky: The food should not be sticky or gluey, as this can increase choking risk.
- Moderate chewing required: Unlike pureed diets, this level requires moderate chewing ability.
Foods Included in a Stage 6 Diet
This diet includes a wide variety of modified foods, prepared with care to ensure they are soft, moist, and bite-sized.
- Protein: Tender, moist, and finely chopped or minced meats and poultry in a thick sauce or gravy. Soft, flaky fish (without bones) and well-cooked eggs (scrambled, poached) are also suitable.
- Grains and starches: Well-cooked, soft pasta and rice with a thick sauce. Fully soaked, soft breakfast cereals like porridge or Weetabix.
- Fruits and Vegetables: Soft, cooked, or canned fruits and vegetables with skins, pips, and seeds removed. Examples include soft-cooked carrots, boiled broccoli florets, and ripe bananas.
- Dairy and desserts: Smooth yogurt, custard, milk puddings, and soft sponges soaked in custard or syrup are appropriate options.
Foods to Avoid on a Stage 6 Diet
Certain food textures pose a high risk of choking or aspiration and must be strictly avoided.
- Hard, chewy, or crunchy foods: Crusty bread, nuts, crackers, crisps, raw vegetables and fruits, and steak.
- Stringy or fibrous textures: Celery, pineapple, peas with skins, and runner beans.
- Sticky foods: Peanut butter, marshmallows, and overcooked oatmeal that becomes gluey.
- Crumbly foods: Pastries, dry cakes, and bread crusts.
- Foods with skins, husks, or seeds: Grapes, corn, and fruit with pips.
- Mixed consistency foods: Soups with large lumps and thin broth, or mince in thin gravy.
Comparison of IDDSI Levels 5, 6, and 7
To understand the progression of modified diets, it is helpful to compare the different IDDSI levels for food textures.
| Feature | Level 5 (Minced & Moist) | Level 6 (Soft & Bite-sized) | Level 7 (Regular) |
|---|---|---|---|
| Particle Size | Adult: 4mm lumps | Adult: 1.5cm x 1.5cm pieces | Not restricted |
| Chewing Required | Minimal chewing | Moderate chewing | Normal chewing |
| Moisture | Moist and cohesive | Soft, tender, and moist | Varies |
| Fork Test | Lumps easily separated | Easily mashes with a fork | Passes if food is naturally soft |
| Texture | Lumps are soft and easily squashed with tongue | Soft, tender, no separate thin liquid | Hard, chewy, crispy, or crunchy may be included |
Clarifying the 'Stage 6' Terminology
The term 'Stage 6 diet' is not standard medical terminology, and a search often leads to information about kidney disease. It is important to clarify that Chronic Kidney Disease (CKD) is classified into five stages (G1 to G5), with G5 representing end-stage kidney failure. There is no 'Stage 6' in this classification. Therefore, referencing a 'Stage 6' diet is almost always a reference to the IDDSI Soft and Bite-sized diet for dysphagia, not a renal diet. Individuals with CKD follow a renal diet tailored to their specific stage, which may involve modifying protein, sodium, potassium, or phosphorus intake, not just texture.
Safe Food Preparation Tips
- Use Moisture: Add thick sauces, gravies, or melted cheese to food to increase moisture and make it easier to swallow.
- Test for Softness: A simple test is to press the food with a fork until your thumbnail turns white. If it mashes easily without regaining its shape, it's likely soft enough.
- Chop Accurately: Use a fork to measure pieces. The pieces for an adult should be no larger than the width of the fork.
- Enrich Your Food: To prevent unintended weight loss, add extra calories and protein with full-fat dairy products, fortified milk, or healthy oils.
Conclusion
The stage 6 diet is a vital part of managing dysphagia, providing a safe and nutritious way for people to eat when chewing and swallowing are compromised. Adhering to the specific requirements of the IDDSI Soft and Bite-sized level is crucial for preventing serious complications like choking. It is also important to recognize that the term 'stage 6 diet' is associated with this dysphagia-related texture modification and is distinct from managing late-stage kidney disease. For anyone unsure about dietary modifications, always consult a healthcare professional, such as a Speech and Language Therapist or a registered dietitian. For comprehensive information on all levels, visit the official IDDSI website.
Outbound link:
International Dysphagia Diet Standardisation Initiative (IDDSI)
