The international dysphagia diet standardisation initiative (IDDSI) is a continuum of food and drink modifications that was created to provide common terminology and textures of food and drink around the world. There are 8 levels in total, 0-4 pertaining to drinks or fluids and 3-7 to food or diet. Having common terminology, colours and symbols across contexts makes things easier for people living with dysphagia and for clinicians too.
In order to be recommended a certain consistency, a person with dysphagia or any kind of swallow difficulty must be assessed by a speech pathologist to ascertain the function of their swallow and therefore find their optimal diet and fluid consistencies. The IDDSI website explains each consistency and its criteria, and potential reasons for why that modification is appropriate. However, I’ll be giving a quick rundown 😎
Level 7 or Regular Diet is considered a “normal diet” with no modifications necessary to make food safe for a person. Because any and every kind of food falls into this category, it is likely how most people would describe their diet in relation to IDDSI levels and includes some of the most notoriously difficult foods to eat such as steaks, toast, crusty bread, flaky pastry, seeds, skins and fibrous foods.
Within the same level, seven, there is a sub group so to speak, called Regular Easy to Chew. This is still considered a normal diet and emphasises foods that are naturally soft and of any size however there is a small exclusion criteria to ensure safety. This diet avoids hard, tough, chewy, fibrous, stringy, crunchy and crumbly foods, and pips, seeds, husks and bones. This is because most foods that can be described as such require;
Good or strong chewing ability to prepare the food adequately in order to swallow safely,
Adequate tongue strength to ensure nothing gets stuck or pockets in the mouth,
Enough saliva to lubricate the food and help break down,
Ability to hold food in the mouth while swallowing sauce or liquid in the dish,
Ability to separate and get rid of bits and pieces that are not safe to swallow,
Sufficient endurance to last a full meal time safely.
The IDDSI website outlines the Fork Pressure Test as a way to assess quickly and effectively whether or not something is Regular Easy to Chew and therefore, appropriate to eat for this recommendation. All that is required is a fork and a small piece or sample of the food.
You should be able to break the piece of food up with the side of a fork. In other words, a knife should not be needed to break up the food or eat the dish, per se.
The food should be soft enough that when you press down on it gently with the fork, until your thumbnail turns white, it should squash and not return to its original shape.
These simple tests are indicative of what force might be required to chew and prepare the food before swallowing and whether or not the food could pose a choking risk.
Even though this level is still considered “regular” food, it’s important to note how such small choices can make something “Easy to Chew” and can empower someone to eat a meal safely and confidently. With the small modifications and choices noted above, the meal can become accessible to a person with dysphagia, giving them the capacity to participate in shared mealtimes with friends and family and gain a sense of belonging and inclusion.
** 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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