Food & Nutrition
Staff In-Service:
Dysphagia Diets
& IDDSI
Gabrielle Haskell, Illinois State University Dietetic Intern
What are dysphagia and IDDSI?
Dysphagia is when individuals have difficulty swallowing
Patients with dysphagia can choke easily
Many patients with dysphagia need to eat special diets to reduce the risk of choking
IDDSI stands for the International Dysphagia Diet Standardization Initative
(Blinka, 2021) This presentation is for educational purposes only. 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.
What is the purpose of IDDSI?
IDDSI is a standard that is used in many healthcare settings to describe texture
modified foods and thickened liquids for patients with difficulty swallowing
IDDSI has 8 levels (0 through 7); Drinks= 0-4; Food= 3-7
These levels are used to describe textures of foods and thicknesses of drinks
Each level has a different name, number and color
This presentation is for educational purposes only. 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.
IDDSI Framework (Pyramids)
This presentation is for educational
purposes only. These are NOT official
IDDSI resources, educational materials or
education programs and they are NOT
meant to replace materials and resources (IDDSI, 2022).
on www.IDDSI.org.
IDDSI Previous Terminology
Honey thick
Nectar thick
(NHS).
This presentation is for educational purposes only. 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.
Drinks Level 0: Thin (TN0)
Fast flowing liquid that flows like water
Can be consumed through a cup or straw
For those who are able to drink all types of liquids (no
swallowing problems)
(GettyImages, 2020). (Day, 2020).
Examples: water, coffee, tea,
milk, juice, soft drinks
This presentation is for educational purposes only. 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.
Drinks Level 1: Slightly Thick (ST1)
Thicker than water; requires more effort to drink than thin
liquids; flows slower than thin liquids; flows through a straw
Often used for infants and children as a thick drink
(formula in a bottle)
Used for adults who can not drink thin, fast flowing liquids
Examples: some fruit
nectars and milks
This presentation is for educational purposes only. These are NOT official IDDSI resources, educational
materials or education programs and they are NOT meant to replace materials and resources on
(Pfanner, n.d.). www.IDDSI.org.
Drinks Level 2: Mildly Thick (MT2)
Flows off a spoon, sippable
Pours quickly from a spoon, but slower than a thin or
slightly thin drink
Used for those who have tongue control issues and those
who can not have thin drinks
Example: milk shakes
This presentation is for educational purposes only. These are NOT official IDDSI resources, educational
materials or education programs and they are NOT meant to replace materials and resources on
(Gore, 2020). www.IDDSI.org.
Drink Level 3: Moderately Thick (MO3)
& Food Level 3: Liquidized (LQ3)
Can be drunk from a cup or eaten with a spoon (NOT a fork)
No chewing required
Smooth texture with no bits/chunks
For those who have pain swallowing or issues moving their tongue
Examples: soup with no chunks, yogurt
This presentation is for educational purposes only. These are NOT official IDDSI resources, educational
(IDDSI, n.d.). materials or education programs and they are NOT meant to replace materials and resources on
www.IDDSI.org.
Drink Level 4: Extremely Thick (EX4) &
Food Level 4: Pureed (PU4)
Normally eaten with a spoon (can be eaten with a fork)
Hard to drink from a cup and cannot be sucked through a
straw
Does not require biting or chewing; not sticky or lumpy
For those who have pain when chewing or swallowing
or who have missing teeth
Example: pureed
foods
(NHS; Oak House Kitchen, n.d.).
This presentation is for educational purposes only. 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.
Food Level 5: Minced & Moist (MM5)
Eaten with a spoon, fork, or chopsticks
Soft and minced foods (can see lumps)
No biting needed; small amount of chewing is needed
For those who have pain when chewing (or are tired when chewing) or who have
missing teeth
Example: finely minced, chopped, mashed foods (mashed
potatoes, mashed bananas)
This presentation is for educational purposes only. 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.
(Gagnon, 2021).
Food Level 6: Soft & Bite-Sized (SB6)
Eaten with a spoon, fork, or chopsticks
Foods can be mashed with pressure from forks, spoons, and
chopsticks
Knife not required to cut food, but may be used to help
Soft, tender and moist foods; chewing required before swallowing
Biting not required
For those who have pain or fatigue chewing, missing teeth, poorly fitting dentures (NHS, n.d.).
Example: Tender pieces of food no bigger than 15
mm pieces for adults (Cooked meat, fish,
casserole, fruit, veggies, cereal)
This presentation is for educational purposes only. 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.
Food Level 7: Easy to Chew (EC7)
Normal, everyday foods; soft/tender textures
Any method can be used to eat these foods
Sample size is not restricted at Level 7; foods can be a range
of sizes
No hard, tough, chewy, fibrous, stringy, crunchy, or crumbly bits, pips, seeds, fibrous
parts of fruit, husks, or bones
(IDDSI, n.d.).
Requires the ability to bite soft foods & chew foods before swallowing
This level could be a risk for people who are at risk for choking
Examples: Tender pieces of food (meats, fish, fruit, vegetables); texture
softened cereal
This presentation is for educational purposes only. 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.
Food Level 7: Regular (RG7)
Normal, everyday foods; soft/tender textures
Any method can be used to eat these foods
Sample size is not restricted at Level 7; foods can be a range
of sizes
Includes hard, tough, chewy, fibrous, stringy, crunchy, or crumbly bits, pips, seeds, fibrous
parts of fruit, husks, or bones
Ability may be needed to bite hard and soft foods & chew before swallowing; bones may
need to be removed in food
For those who do not have problems swallowing or chewing
Examples: Regular foods
Why do you need to know this?
IDDSI promotes SAFETY!
If a patient is on a special diet for dysphagia or swallowing/chewing difficulty, it
will be noted on their tray ticket
We should check the ticket, look for IDDSI terminology, and make sure that the
patient does not get served foods/drinks they can not consume
If we all understand the IDDSI framework and terminology, we can check trays
If you notice a food/drink on the patients tray that they cannot consume,
you could possibly save a patient from choking
This presentation is for educational purposes only. 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.
Food Level 6: Soft &
Bite-Sized (SB6)
Drinks Level 2: Mildly
Thick (MT2)
Should a patient falling under level 4 (pureed;
PU4) on IDDSI be served this meal?
(Culinary Specialties, 2021).
This presentation is for educational purposes only. 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.
Meal for Level 4: Pureed
(Roche, 2021).
This presentation is for educational purposes only. 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.
Thank you for
listening! Do you
have any
questions?
References
Better Hospital food without increasing labor expense. Culinary Specialties Quality Foods for Hotels Conventions Caterers and more. (2021, August 31). Retrieved June 20, 2022, from
https://www.culinaryspecialties.net/better-hospital-food-without-increasing-labor-expense/
Blinka, D. (2021). Diagnosing dysphagia. wikiHow. Retrieved June 14, 2022, from https://www.wikihow.com/Treat-Dysphagia.
Day, C. (2020, May 10). How to make black coffee that tastes good. Someday I'll learn. Retrieved June 16, 2022, from https://somedayilllearn.com/how-to-make-black-coffee/
Gagnon. (2021, July 15). 24 genius baking ingredient swaps when you're out of ingredients. Eat This Not That. Retrieved June 16, 2022, from https://www.eatthis.com/healthy-baking-
ingredients/
Getty Images. (2020, January 27). The truth about hydration: Should you drink eight glasses of water a day? The Guardian. Retrieved June 16, 2022, from
https://www.theguardian.com/lifeandstyle/2020/jan/27/the-truth-about-hydration-should-you-drink-eight-glasses-of-water-a-day
Gore, M. (2020, May 13). Have the *perfect* milkshake whenever you want with this easy recipe. Delish. Retrieved June 16, 2022, from https://www.delish.com/cooking/recipe-
ideas/a20760804/easy-milkshake-recipe/
Mayo Clinic Staff. (2021, October 20). Dysphagia. Mayo Clinic. Retrieved June 14, 2022, from https://www.mayoclinic.org/diseases-conditions/dysphagia/symptoms-causes/syc-
20372028#:~:text=Dysphagia%20is%20difficulty%20swallowing%20%E2%80%94%20taking,some%20cases%2C%20swallowing%20is%20impossible
NHS. (n.d.). Food and fluid terminology (IDDSI). NHS choices. Retrieved June 16, 2022, from https://www.stgeorges.nhs.uk/service/therapies/speech-and-language-therapy/our-new-
fluid-and-diet-terminology/
Recipes for IDDSI level 4 food - dysphagia recipes. Oak House Kitchen. (n.d.). Retrieved June 16, 2022, from https://www.oakhouse-kitchen.com/recipes-for-dysphagia/swallowing-
difficulties/recipes-for-iddsi-level-4-food/
Roche. (2021, March 24). Starting with purees: Implementing IDDSI in healthcare: Thick-it®. Thick. Retrieved June 20, 2022, from https://thickit.com/blog/2020/09/30/starting-with-
purees-implementing-iddsi-in-healthcare/
The IDDSI framework. IDDSI. (n.d.). Retrieved June 14, 2022, from https://iddsi.org/framework/
What’s the difference between 100% juice, a nectar and a fruit juice drink? Pfanner. (n.d.). Retrieved June 16, 2022, from https://www.pfanner.com/en/fruit-facts/whats-the-
difference-between-100-juice-a-nectar-and-a-fruit-juice-drink/
