Most people don’t think twice about swallowing until something goes wrong. Maybe you had food “go down the wrong way,” or suddenly felt like a bite of food was stuck. That moment can be scary and it can leave you wondering what’s happening and what you should do next.
For some, it’s a one-off event. For others, it might be the start of something called dysphagia, which just means “trouble swallowing.” Dysphagia can happen for a lot of reasons from muscle changes, to dental issues, to anxiety (sometimes called pseudodysphagia). Whatever the cause, one thing people quickly realize is that not all foods feel the same to swallow.
That’s where the IDDSI Framework comes in. IDDSI stands for the International Dysphagia Diet Standardization Initiative. A group of healthcare and food industry experts from around the world collaborated on a common way to describe levels of food and drink textures. Modifications in the cutting, cooking and presenting phases of recipes could be used to fit where a person was with their chewing and swallowing in that moment.
There are 8 different levels that can be seen as rungs on a ladder moving from the completely unchanged, Regular Foods 7 and Thin Liquids 0, to the most processed texture levels, which meet in the middle as the two shared levels of Pureed/Extremely Thick 4 and Liquidized/Moderately Thick 3.
Each level has simple tests that use handy tools, like spoons, forks, chopsticks so anyone can check if a food or drink fits the level.
I am writing a follow-up to this post with an informal way of estimating your current diet texture. While it does not replace a formal assessment from a licensed speech-language pathologist, many people just need a hand understanding this sudden change and help staying safe and fed as it is resolving. Once you have an idea for you current IDDSI level, you can follow the texture modifications at the end of any of my recipes to make it fit you in this moment. Return to this page to learn more about each new IDDSI level as you make progress. Continue below for the breakdowns for each food texture level.
Liquidized 3: This is the starting texture point for foods, although it shares characteristics with liquids, like being able to drink it from a cup. There is no chewing needed with Liquidized 3, you can swallow this directly. Some foods that may naturally test at this level include some sauces/gravies, runny purees, syrups. Testing: When placed on a fork, the food will flow through the prongs of the fork in dollops; when pressed into the surface, the fork does not leave a clear pattern on the surface. With a spoon, it will pour easily when tilted and not stick to the spoon.
Pureed 4: While this level also does not require chewing, you should not be able to drink it via a cup. Thick cereals like Cream of Wheat and blended soups often test at this level. Testing: When scooped with a fork, the bite will sit on the prongs and not drip continuously and when pressed into the surface, will leave an indentation. For the spoon, the full bite should slide off when tilted sideways with a very gentle flick with no thick residue left.
Minced & Moist 5: This level does require minimal chewing but not biting. Fatiguing quickly or missing teeth can point people toward this level. Meats, fruits, and vegetables should be finely minced without excess liquids, breads pregelled and grains not sticky. Testing: A bite sits on top of the prongs without falling through and pressed into the bites the particles easily separate with little pressure. A bite will hold its shape on a spoon and slide/pour off if tilted (not too sticky).
Soft & Bite-Sized 6: Greater chewing endurance and tongue force are needed for this next level, while keeping bites manageable. 15mm is the recommended size and tough foods with fibers and skins are kept off or minced. Breads should also be pregelled at this point. Testing: Able to cut a bite off with a fork, and when pressed with the pressure to where your thumbnail blanches to white, the item will break apart and not return to its original shape. You can replicate the test with a spoon or even fingers.
Easy to Chew 7: This will require the ability to bite soft foods as well as endurance for chewing. There is not bite size for this level, so it is often where people with temporary changes, like dental procedures (braces, wisdom teeth removal), tend to land. Tender cooked meats, fruits, vegetables and grains can all be enjoyed. Testing: Fork/spoon/finger pressure with the blanching of thumbnail causes the food to change shape once removed. You can easily cute a bite with a spoon or fork.
How to utilize IDDSI
If swallowing feels effortful or unsafe, experimenting with food and drink textures might help you figure out what feels easier. You don’t need to overhaul your whole diet overnight, sometimes a small change (like making rice softer, or thickening liquids a little) can make a big difference in comfort and confidence.
That said, IDDSI isn’t about “restricting” you forever. It’s more like a toolkit. If you find that one level works better for now, you can stick with it and later try moving up the ladder as you feel ready.
Remember: you don’t have to figure this out alone. If swallowing problems stick around or get worse, it’s always worth checking in with a medical provider or speech-language pathologist.
For more resources and to read about the framework yourself, you can visit IDDSI’s website and their YouTube Channel.
Images included in this article were created by IDDSI and are part of the free resources. The IDDSI Framework and Descriptors are licensed under the CreativeCommons Attribution-Sharealike 4.0 International License https://creativecommons.org/licenses/by-sa/4.0/
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