Level 6 or Soft and Bite Sized describes foods that are soft, just like Regular Easy to Chew, but also cut up into small pieces. Each piece is meant to be 1.5cm or smaller and for children, 8mm or smaller. This is because pieces this size or smaller help to mitigate the risk of complete airway obstruction, or choking, in the case that food goes down the wrong way.
Being of a soft consistency, it also means that there is less strength, effort and duration required to appropriately chew and prepare the food before it is swallowed. Although chewing is required, biting is not as the food is already cut up into small pieces. This means that this consistency is likely more appropriate for people with missing teeth, ill fitting dentures, oral pain, weakness and/or fatigue on chewing. However, adequate tongue strength is still needed to move the food around the mouth, keep the food from spilling backwards, and when ready, propel it into the throat to swallow. It's also pretty important to ensure that the foods are moist and not too dry!
Some examples of foods that are often consumed under this level include;
Cut up and tenderly cooked meat
Flaky soft fish
Soft cooked vegetables
Small sized pieces of pasta
Soft fruit that are cut up but skinned and de- seeded
Cereal that consists of small pieces.
To be clear, most kinds of bread do not pass as soft and bite sized as they can be dry, chewy and stodgy and can be a huge choking risk! This means that sandwiches cut up are usually not appropriate for people recommended this level.
It's also important to note when there is too much liquid in the dish, which is known as "dual consistency." If there is excess liquid to the point that it can be scooped up with a teaspoon, then there is too much liquid and the food should be either drained or not served as a soft and bite sized meal.
Another sneaky one is cereal 😏 Small pieces of cereal are a great option in terms of size however, the cereal will likely need to be soaked before eating to ensure it abides by the "soft" in "soft and bite sized." You need to have a sharp eye when measuring how much milk you use to soak the cereal so you don't end up with a dual consistency OR just remove the excess (like the rest of us).
Some things to avoid can include chunky soup, raw nuts and vegetables, fruits with skins and seeds, steak, bread and toast, chips (crisps), food with husks, leafy foods and foods that form crusts (i.e. cheese when baked).
As described in the last post, a great way to test whether or not a dish fits the soft and bite sized criteria is to use the fork test- press down on the piece with a fork gently until your thumbnail turns white. If the piece of food is squashed and does not spring back or return to its original shape, it has passed! If the piece requires more effort to squash or rebounds in shape then it is not soft enough to pass as soft and bite sized and therefore could be a choking risk.
Being the first level in IDDSI to truly require modifications to food, this is where things get interesting.. but also, creative! There are so many delicious foods that fall into this category, sometimes all you need are some tips, tricks and a little bit of inspiration ✨ I hope this post helps you to get innovative or inspire you to try out one of my recipes 😊 and I promise, they're tasty enough to eat even if you don't have dysphagia which makes them perfect to create an inclusive experience so they can be shared with family and friends of all mealtime needs.
** 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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