ALL ABOUT IDDSI
Name That liquid level
Even the odds
Name that Food Level
Fix that Order
100
What does IDDSI stand for?
International Dysphagia Diet Standardisation Initiative (IDDSI)
100
Flows like water • Fast flow • Can drink through any type of teat/nipple, cup or straw as appropriate for age and skill
0-THIN
100
This function requires the coordinated effort of over thirty muscles, the central nervous system, and five cranial nerves
Swallowing
100
• Normal, everyday foods of soft/tender textures that are developmentally and age appropriate • Any method may be used to eat these foods • Sample size is not restricted at Level 7, therefore, foods may be of a range of sizes Ø Smaller or greater than 8mm pieces (Paediatric) Ø Smaller or greater than 15 mm = 1.5 cm pieces (Adults) • Does not include: hard, tough, chewy, fibrous, stringy, crunchy, or crumbly bits, pips, seeds, fibrous parts of fruit, husks or bones
7-EASY TO CHEW
100
Regular, Mechanical Soft, Chopped Meats/Bite Size/IDDSI 6 Special Instructions: Double protein add EBC with all meals
Soft & Bite size, Level 6
Thin liquids, Level 0
Special Instructions: Double protein; EBC with all meals
200
Why was IDDSI established
To provide a common terminology to describe food textures and drink thickness
To offer detailed level definitions and testing methods To create testing methods that are easy, reliable, and accessible
200
• Thicker than water • Requires a little more effort to drink than thin liquids • Flows through a straw, syringe, teat/nipple • Similar to the thickness of most commercially available ‘Anti-regurgitation’ (AR) infant formulas
1- Slightly thick
200
Odds of someone with ought dysphagia choking on food?
1 in 2400
200
• Normal, everyday foods of various textures that are developmentally and age appropriate • Any method may be used to eat these foods • Foods may be hard and crunchy or naturally sof 
7-REGULAR
200
Regular, Pureed, Level 4. Special Instructions: Regular/pureed diet/thin liquids
Pureed, Level 4
Thin liquids, Level 0
No restrictions
300
What are transitional Foods?
Start as one texture and change into another when moisture is applied or change in temperature occurs
300
Can be drunk from a cup • Moderate effort is required to suck through a standard bore or wide bore straw (wide bore straw = 0.275 inch or 6.9 mm) • Cannot be piped, layered or molded on a plate because it will not retain its shape • Cannot be eaten with a fork because it drips slowly in dollops through the prongs • Can be eaten with a spoon • No oral processing or chewing required – can be swallowed directly • Smooth texture with no ‘bits’ (lumps, fibers, bits of shell or skin, husk, particles of gristle or bone)
3-MODERATELY THICK
300
How many choking related deaths in 2022
5,554 in the USA and over 100,000 worldwide
300
• Can be eaten with a fork or spoon • Could be eaten with chopsticks in some cases, if the individual has very good hand control • Can be scooped and shaped (e.g. into a ball shape) on a plate • Soft and moist with no separate thin liquid • Small lumps visible within the food Ø Paediatric, equal to or less than 2 mm width and no longer than 8mm in length Ø Adult, equal to or less than 4mm width and no longer than 15mm in length • Lumps are easy to squash with tongue 
5-MINCED AND MOIST
300
Renal, Minced Moist, Level 5. Special Instructions: CHOPPED MEATS
Minced & Moist, Level 5
Thin liquids, Level 0
Renal
400
What age range was IDDSI made for?
All ages!
400
• Usually eaten with a spoon (a fork is possible) • Cannot be drunk from a cup because it does not flow easily • Cannot be sucked through a straw • Does not require chewing • Can be piped, layered or molded because it retains its shape, but should not require chewing if presented in this form • Shows some very slow movement under gravity but cannot be poured • Falls off spoon in a single spoonful when tilted and continues to hold shape on a plate • No lumps • Not sticky • Liquid must not separate from solid
4-EXTREMELY THICK/PUREED
400
At what age does the rate of choking related deaths increase?
71
400
4-PUREED
400
Regular
Regular, Level 7
Thin liquids, Level 0
No restrictions
500
This item is not recommended on IDDSI’s texture modified diets -Is a very common item that can be associated with choking or airway blockage -Should be assessed for safety by swallowing specialist for texture modified diets - May be provided to meet person’s preferences and wishes according to their goals of care with adequate documentation
Bread
500
• Flows off a spoon • Sippable, pours quickly from a spoon, but slower than thin drinks • Mild effort is required to drink this thickness through standard bore straw (standard bore straw = 0.209 inch or 5.3 mm diameter)
2- MILDLY THICK
500
Average patient age for Magnolia Manor West
76
500
• Can be eaten with a fork, spoon or chopsticks • Can be mashed/broken down with pressure from fork, spoon or chopsticks • A knife is not required to cut this food, but may be used to help load a fork or spoon • Soft, tender and moist throughout but with no separate thin liquid • Chewing is required before swallowing • ‘Bite-sized’ pieces as appropriate for size and oral processing skills Ø Paediatric, 8mm pieces (no larger than) Ø Adults, 15 mm = 1.5 cm pieces (no larger than) 
6-SOFT AND BITE SIZED
500
Regular. Special instrctions: chopped meat; honey thick lquids
Regular; level 7
Moderately thick*, level 3
Special Instructions: Bite sized proteins