Level 5 or Minced and Moist is the next modification on the continuum. It describes foods that are soft and moist and of pieces equal to or less than 4mm and no longer than 15mm in length. For children who require a minced and moist diet, their pieces need to be equal to or less than 2mm instead.
Usually, someone is recommended minced and moist foods because there is no biting and only minimal chewing involved. The tongue can mostly be used to separate the pieces and prepare the food for swallowing. These characteristics compensate for a weak jaw or reduced chewing ability. It’s also indicated for people who have pain on chewing, missing teeth and/or ill-fitting dentures.
Most meat, fish, fruit and vegetables can be consumed as a minced and moist diet if they are prepared properly. Such as being minced or chopped to the right size, cooked to a soft consistency and served in a thick sauce or gravy that ensures the food is moist. Any excess liquid, either from the food or excess sauce, should be drained to ensure the dish does not become of dual consistency (as explained in our last post). This goes the same for grains and cereals that are soft and of the appropriate size ensuring no excess liquid, such as milk, floods the dish.
Rice and other grains in particular should not be sticky or gluggy but also not be dry enough to separate into individual pieces. It should also be served in a thick and smooth sauce to ensure it can be manipulated easily and kept together in the mouth.
The same as soft and bite sized, bread is not a safe option for people on this level although the IDDSI website does provide instructions for how to make minced and moist bread and sandwiches! Skins, seeds, fibrous, stringy, chewy, crumbly and floppy foods should be avoided to ensure the choking risk remains mitigated.
This is where assessing the food for whether or not it is appropriate starts changing compared to the less modified levels.
Always check the size, but rather than measuring pieces of mince in mm’s you can check the size by seeing if it fits between the prongs of a fork- they are usually about 4mm apart.
When checking if it is soft enough, your thumbnail should not have to blanch white but it should be easily squashed by a fork or a spoon.
Another test that hasn’t been discussed yet is the spoon tilt test- the minced should hold its own shape on a tablespoon and slide off easily when tilted or lightly flicked.
Minced and moist foods is where a lot of people start to feel limited in their food options due to the amount of modifications involved. It’s also where the variety in texture, shape and presentation becomes less which can result in texture fatigue and reduced interest in food. There are also fewer naturally occurring meal options under the minced and moist guidelines which means participation and socialising around food is more difficult and the risk of isolation increases. This is why it’s so important to get imaginative and creative regarding what you can do with minced and moist foods so that mealtimes are kept interesting and everyone can happily share the meal together.
** 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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