Level 3 is another IDDSI level that describes both diet and fluid, like puree. However, level 3 can be described as more runny or more fluid-like compared to its level 4 counterpart. It can be sipped from a cup although requires moderate effort to be sipped through a straw, and cannot be eaten with a fork as it would flow through the prongs and therefore must be "eaten" with a spoon. Due to this, it cannot be piped or moulded for presentation so often ends up presented in cups or bowls. This consistency requires no chewing or oral preparation and therefore only requires posterior transfer in the mouth to be swallowed making it appropriate for people who;
Require more time to control the flow of drinks in their mouth as less viscous fluids may move too rapidly,
Require more time to commence the action or reflex of swallowing,
Have a strong enough tongue to transfer the drink backwards but may not have enough strength to do so with more solid foods,
Are unable to chew effectively and/or,
Have pain on swallowing,
Have significant pharyngeal residue with more solid foods where a choking risk is identified through instrumental assessment.
Like puree, it is less about what foods are used but more so how they are prepared and liquidised. Obviously, some foods will be more appropriate and less work to prepare than others however it is more important to ensure the smooth texture without lumps and the flow rate of the food or drink. This can be measured in a couple of different ways . They include;
Spoon tilt test- the product should flow off the spoon easily and does not stick.
Fork drip test- the product should slowly drip through the prongs of the fork, in dollops. When the fork is pressed on the surface of the product, it should NOT leave a clear imprint and if poured on to a flat surface, it should easily spread out, NOT hold its own shape.
Syringe test- If the barrel of a 10ml syringe is filled and the plunger removed, less than 2ml of liquidised/moderately thick fluids should drip through the needle hub over 10 seconds. Any more than 2ml would indicate a different fluid level and be too thin. If nothing dripped out, it would likely indicate a pureed consistency and would be too thick. Essentially, more than 8ml should remain in the barrel. The IDDSI website has further instructions and videos if you wish to observe this method and/or have access to 10ml syringes for testing in the kitchen.
Liquidised poses a particular difficulty when it comes to varying textures and presentations as it is difficult to shape and mould and must be smooth in texture. Again, like puree, ways to keep the menu versatile and interesting should include things like colour, temperature and bold flavours where possible to avoid compromise to appetite. Again though, with a bit of creativity and inspiration, a liquidised dish can be just as appetising as a more solid one and can be happily shared with others, and should be, in order to engage in the mealtime experience and maintain a sense of inclusion and togetherness ✨
** These posts are not meant to be used as a diagnostic tool. Diet and fluid recommendations should be prescribed by a practicing speech pathologist. **
** ‘These are NOT official IDDSI resources, educational materials or education programs and they are NOT meant to replace materials and resources on www.IDDSI.org’ **
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