What is the IDDSI scale for?

Approximately one in 25 adults experiences a swallowing problem each year. The International Dysphagia Diet Standardisation Initiative, or IDDSI scale, provides a universal framework to classify food and drink textures, significantly enhancing safety and communication for individuals with dysphagia.

Quick Summary

The IDDSI scale is a standardized framework for classifying modified food textures and liquid thickness, used primarily for individuals with swallowing difficulties (dysphagia) to improve safety.

Key Points

• Standardization: The IDDSI scale provides a global, consistent framework for classifying modified diets and thickened liquids.

• Enhanced Safety: It significantly reduces the risk of choking and aspiration for individuals with dysphagia (swallowing difficulties).

• Clear Terminology: IDDSI replaces outdated and inconsistent diet names with clear, numbered, and color-coded levels.

• Simple Testing: The framework includes easy-to-use testing methods using common utensils like forks, spoons, and syringes.

• Broad Application: It is applicable across all age groups, care settings, and cultures, from infants to the elderly.

• Interprofessional Tool: IDDSI facilitates better communication and teamwork among dietitians, SLPs, nurses, and kitchen staff.

• Patient Benefits: Consistent preparation and safe textures can improve nutritional intake and reduce mealtime anxiety for patients with dysphagia.

Understanding the IDDSI Scale and Dysphagia

Before the widespread adoption of the International Dysphagia Diet Standardisation Initiative (IDDSI), healthcare professionals and caregivers faced significant challenges due to inconsistent terminology for diet modifications. Phrases like 'minced', 'soft', and 'honey-thick' meant different things across various institutions and countries, leading to dangerous and sometimes fatal errors in patient care. In response, an international, interdisciplinary group of volunteers developed the IDDSI framework to create a universal, standardized system. This framework provides clear descriptions and simple, practical testing methods to ensure that food and drinks are prepared to a consistent texture and thickness.

Dysphagia is the medical term for difficulty swallowing, a symptom caused by a variety of medical conditions. These can include neurological disorders such as stroke, Parkinson's disease, and dementia, as well as head or neck cancer, muscular dystrophy, or structural issues. For individuals with dysphagia, improperly textured food or liquids can lead to aspiration (when food or liquid enters the lungs), which can cause serious health complications like pneumonia. The IDDSI scale is a critical tool in managing this risk by providing a common language and methodology for all involved in patient care, from speech-language pathologists (SLPs) and dietitians to kitchen staff and family caregivers.

The IDDSI Framework: A Continuum of Levels

The IDDSI framework consists of eight numbered levels, from 0 to 7, each associated with a specific color, descriptor, and set of testing methods. The framework is designed as a continuum, accommodating all ages, care settings, and cultural contexts. The lower levels (0-4) focus on liquids, while the higher levels (3-7) focus on foods, with an overlap at levels 3 and 4.

IDDSI Liquid Levels

IDDSI defines five levels of liquid thickness, which are verified using the IDDSI Flow Test with a 10ml syringe.

• Level 0 (Thin): Flows like water. Examples include water, coffee, or milk. This level is for those who can safely manage thin liquids.
• Level 1 (Slightly Thick): Thicker than water but can still flow through a straw.
• Level 2 (Mildly Thick): Mildly thickened, flows quickly off a spoon but leaves a slight coating.
• Level 3 (Moderately Thick): Flows more slowly, often described as 'honey-like'. Can be drunk from a cup or spooned.
• Level 4 (Extremely Thick): Extremely thick, cannot be poured, and holds its shape on a spoon.

IDDSI Food Levels

IDDSI describes food textures based on factors like particle size, moisture, and cohesiveness. Testing methods include the Fork Drip, Spoon Tilt, and Fork Pressure Tests.

• Level 3 (Liquidised): Food that can be drunk from a cup, with no lumps, and requires no chewing. This level overlaps with extremely thick drinks.
• Level 4 (Pureed): Smooth, thick, and lump-free. Holds its shape but not firm. This level overlaps with extremely thick drinks.
• Level 5 (Minced & Moist): Finely minced food with small, soft, and moist particles. Requires some chewing ability.
• Level 6 (Soft & Bite-Sized): Soft, tender, and moist foods cut into bite-sized pieces.
• Level 7 (Regular/Easy to Chew): Regular food textures, with 'Easy to Chew' being a sub-category for items that are tender and soft.

IDDSI Food and Liquid Comparison

IDDSI Level	Descriptor	Food Characteristics	Liquid Characteristics	Testing Methods
0	Thin	N/A	Flows like water	Flow Test
1	Slightly Thick	N/A	Thicker than water, flows from a straw	Flow Test
2	Mildly Thick	N/A	Flows off spoon easily, sippable	Flow Test
3	Moderately Thick / Liquidised	Can be drunk from a cup, no lumps	Drips slowly in dollops	Flow Test, Fork Drip Test
4	Extremely Thick / Pureed	Holds shape on a spoon, no lumps	Holds shape on a spoon	Fork Drip Test, Spoon Tilt Test
5	Minced & Moist	Moist, soft particles (<4mm), requires chewing	N/A	Spoon Tilt Test, Fork Pressure Test
6	Soft & Bite-Sized	Soft, tender, moist, bite-sized (<1.5cm)	N/A	Fork/Spoon Pressure Test
7	Easy to Chew / Regular	Normal, regular texture foods	N/A	Fork/Spoon Pressure Test (Easy to Chew)

Benefits for Patients and Professionals

The IDDSI framework offers numerous advantages for both patients and the healthcare system. It significantly reduces the risk of aspiration and choking by ensuring consistent food and drink textures, leading to improved patient safety. For healthcare providers, the standardized terminology improves communication across departments and facilities, minimizing the risk of errors. Training staff on IDDSI testing methods is straightforward and uses readily available utensils, making implementation practical and effective. From a patient perspective, the clear standards can reduce anxiety around mealtimes, leading to better nutritional intake and overall quality of life. The framework also supports interprofessional collaboration, uniting dietitians, SLPs, nurses, and kitchen staff in a shared mission of patient safety.

Implementation in the Real World

Implementing the IDDSI scale requires a collaborative approach involving multiple departments within a facility. Key steps include reviewing existing diet definitions, mapping them to the new IDDSI levels, and providing comprehensive training to all staff. The IDDSI website provides numerous free resources, including guides and videos, to assist with the transition. As organizations like the American Speech-Language-Hearing Association (ASHA) and the Academy of Nutrition and Dietetics (AND) formally support IDDSI, it solidifies its status as the global standard for dysphagia management. The shift away from older, regional systems, such as the National Dysphagia Diet (NDD) in the United States, demonstrates a worldwide commitment to improving patient safety and care.

Conclusion: Safer Swallowing Through Standardization

In summary, the IDDSI scale is a crucial tool designed to standardize food and liquid textures for individuals with dysphagia. By replacing inconsistent local terminologies with a universal, evidence-based framework, it provides clear communication and consistent safety measures across all care settings. This standardization minimizes the risk of serious complications like choking and aspiration pneumonia, ultimately improving patient health and safety. The framework's accessible testing methods and comprehensive guidelines make it a vital component of modern dysphagia management, empowering both healthcare professionals and caregivers to provide the best possible care. For more information, visit the official IDDSI website at https://www.iddsi.org/.

Frequently Asked Questions

Who is the IDDSI scale for?

The IDDSI scale is for individuals of all ages who have dysphagia, or difficulty swallowing. It helps healthcare professionals, caregivers, and patients understand and manage specific food and drink textures to ensure safe eating and drinking.

What are the eight levels of the IDDSI framework?

The IDDSI framework includes eight levels, numbered 0 to 7. Levels 0-4 classify liquid thickness, while levels 3-7 classify food texture. The levels progress from thin liquids (Level 0) to regular, easy-to-chew food (Level 7).

How do you test for IDDSI levels?

IDDSI provides simple testing methods using standard utensils. Liquids are tested with a 10ml syringe (Flow Test). Foods are tested using a fork or spoon with methods like the Fork Drip Test, Spoon Tilt Test, and Fork Pressure Test.

Why is the IDDSI framework important for patient safety?

The standardized terminology and testing methods of IDDSI reduce the confusion caused by varied diet names. This helps prevent feeding errors that could lead to choking, aspiration, or malnutrition in individuals with swallowing disorders.

Is the IDDSI scale used worldwide?

Yes, IDDSI is a global initiative. It was developed to create a single, shared standard to replace regional variations. As of its launch, it had engagement from over 128 countries and is translated into many languages to ensure international consistency.

Who was involved in creating the IDDSI framework?

The IDDSI framework was developed by an international group of volunteers from various professions, including speech-language pathology, dietetics, medicine, engineering, and food science.

Does IDDSI cover all types of foods?

IDDSI covers a wide range of food and liquid textures suitable for people with dysphagia. It defines textures from liquidised (Level 3) up to regular, easy-to-chew foods (Level 7), including special categories like 'Transitional Foods'.