IDDSI (International Dysphagia Diet Standardization Initiative)

0 Thin Liquids Description/Characteristics

Flows like water

Fast Flow

Can drink through any type of teat/nipple, cup or straw as appropriate for age and skills

Physiological rationale for level 0 thin liquids

Functional ability to safely manage liquids of all types

0 Thin IDDSI Flow Test

Test Liquid flows through a 10 mL slip tipe syringe completely within ten seconds, leaving no residue

1 Slightly Thick Description/Characteristics

Thicker than water

Requires a little more effort to drink than think liquids

Flows through a straw, syringe, teat/nipple

Similar to the thickness of commercially available “Anti-Regurgitation” (AR) infant formula

Level 1 Slightly Thick Liquids IDDSI Flow Test

Test liquid flows through a 10 mL slip tip syringe leaving 1-4 mL in the syringe after 10 seconds

Level 2: Mildly Thick Liquids Description/Characteristics

Flows off a spoon

Sippable, pours quickly from a spoon, but slower than thin drinks

Effort is required to drink this thickness through standard bore straw

Physiological rationale for level 2 mildly thick liquids

If think drinks flow too fast to be controlled safely, these mildly thick liquids will flow at a slightly slower rate

May be suitable if tongue control is slightly reduced

Level 2 Mildly Thick Liquids IDDSI Flow Test

Test liquid flows through a 10 mL slip tip syringe leaving 4 to 8 mL in the syringe after 10 seconds

Level 3 Liquidised solids and moderately thick liquids description and characteristics

Can be drunk from a cup

Some effort is required to suck through a standard bore or wide bore straw

Cannot be piped, layered of moulded on a plate

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

Physiological rationale for this level of thickness

If tongue control is insufficient to manage mildly thick drinks, this level may be suitable

Allows more time for oral control

Needs somme tongue propulsion effort

Pain on swallowing

Level 3 liquidised and moderately thick IDDSI Flow Test

The liquid flows through a 10 mL slip tip syringe leaving > 8 mL in the syringe after ten seconds

Level 3 Liquidised solids and moderately thick liquids fork drip test

Drips slowly in dollops through the prongs of a fork

Prongs of a fork do not leave a clear pattern on the surface

Spreads out if spilled onto a flat surface

Level 3 Liquidised solids and Moderately thick liquids spoon tilt test

Easily pours from spoon when tilted; does not stick to spoon

Level 3 chopstick test

Chopsticks are not suitable for this texture

Level 3 finger test

It is not possible to hold a sample of this food texture using fingers, however, this texture slides smoothly and easily between the thumb and fingers, leaving a coating

Level 3 foods

infant first foods like runny rice cereal or runny pureed fruit

Sauces and gravies

Fruit syrup

Level 4 Pureed Solids and Extremely Thick Liquids Characteristics

Usually eaten with a spoon

Cannot be drunk from a cup

Cannot be sucked through a straw

Does not require chewing

Can be piped, layered or molded

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 plate

No lumps

Not sticky

Liquid must not separate from solid

Physiological rational for Level 4 Pureed Solids and Extremely Thick

If tongue control is significantly reduced, this category may be easiest to manage

Requires less propulsion effort than minced and moist and soft and bite sized and regular but more than liquidised/moderately thick foods

No biting or chewing is required

Increased residue is a risk if too sticky

Any food that requires chewing, controlled manipulation or bolus formation are not suitable

Pain on chewing or swallowing

Missing teeth, poorly fitting dentures

IDDSI Flow Test: Level 4: Pureed Solids and Extremely Thick Liquids

n/a

Fork Pressure Test: Level 4 Pureed Solids and Extremely Thick Solids

The prongs of a fork can make a clear pattern on the surface and/or food retains the indentation from the fork

No lumps

Fork Drip Test: Level 4 Pureed Solids and Extremely Thick Liquids

Sample sits in a mound/pile above fork; a small amount may flow through and form a tail below the fork prongs but it does not flow or drip continously through the prongs of a fork

Level 4 Pureed Solids and Extremely Thick Liquids Spoon Tilt Test

Cohesive enough to hold its shape on the spoon

A full spoonful must plop off the spoon if the spoon is titled or turned sideways; a very gentle flick may be necessary to dislodge with very little food left on the spoon

Sample should not be firm and sticky

May spread out slightly or slump very slowly on a flat plate

Level 4 Pureed Solids and Extremely Thick Liquids Chopstick Test

Chopsticks are not suitable for this texture

Level 4 Pureed Solids and Extremely Thick Finger Test

It is just possible to hold a sample of this texture using gingers

This texture slides smoothly and easily between the fingers and leaves noticeable residue

Level 5: minced and moist description/characteristics

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 on a plate

soft and moist with no separate thin liquid

small lumps within the food

• Paediatric = 2 mm lump size

• Adult = 4 mm lump size

Lumps are easy to squash with tongue

Level 5: minced and moist physiological rationale

biting is not required

minimal chewing is required

tongue force alone can be used to break soft small particles in this texture

tongue force is required to move the bolus

pain or fatigue on chewing

missing teeth, poorly fitting dentures

Level 5: Minced and Moist Fork Pressure Test

when pressed with a fork the particles should easily be separated between and come through the tines/prongs of a fork

can be easily mashed with little pressure from a fork

Level 5: minced and moist fork drip test

A scooped sample sits in a pile or can mound on the fork and does not easily or completely flow or fall through the tines/prongs of a fork

Level 5: Minced and Moist Spoon Tilt test

Cohesive enough to hold its shape on the spoon

A spoonful must slide/pour off the spoon if the spoon is tilted or turned sideways or shaken lightly; the sample should slide off easily with very little food left on the spoon

A scooped mound may spread or slump very slightly on a plate

Level 5: Minced and Moist chopstick test

Chopsticks can be used to scoop or hold this texture if the sample is moist and cohesive and the person has very good hand control

Level 5: minced and moist finger test

It is possible to easily hold a sample of this texture using fingers; small soft, smooth, rounded particles can be easily squashed between fingers. The material will feel moist and leave fingers wet