The International Dysphagia Diet Standardisation Initiative (IDDSI) is a new dysphagia diet standard that started in 2013.  The IDDSI is a dysphagia diet standard that is intended to meet the needs of individuals with dysphagia across the age span, across all care setting and across all cultures.  The IDDSI dysphagia diet standard is called the International Dysphagia Diet Framework.

The IDDSI framework consists of a continuum of 8 levels (0-7).

  • Levels are identified by text labels, numbers, and colour codes to improve safety and identification.
  • The American Academy of Nutrition and Dietetics (AND) and the American Speech-Language-Hearing Association support the implementation of IDDSI framework and definitions
  • Many food companies are transitioning to IDSSI coding on their labels

The IDDSI Framework Descriptors by Level number, color code, name and definitions:

0 (zero), white; Thin; Applies to drinks/fluids

  • Flows like water
  • Fast flow
  • Can drink through any type of cup or straw

1 (one), grey; Slightly thick; Applies to drinks/fluids

  • Thicker than water
  • Requires a little more effort to drink than thin liquids
  • Flows through a straw

2 (two), pink; Mildly Thick; Applies to drinks/fluids

  • Flows off a spoon
  • Sippable, pours quickly from a spoon, but slower than thin drinks
  • Effort is required to drink this thickness through standard straw

3 (three), yellow; Liquidised/Moderately Thick; Applies to food, drinks/fluids

  • Can be drunk from a cup
  • Some effort is required to suck through a standard bore or wide bore straw (wide bore = 0.275” diameter)
  • Cannot be piped, layered or molded 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)

4 (four), green; Pureed/Extremely Thick; Applies to food, drinks/fluids

  • Usually eaten with a spoon (a fork is possible)
  • 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, but cannot be poured
  • Falls off a spoon in a single spoonful when tilted and continues to hold its shape on a plate
  • No lumps

5 (five), orange; Minced and Moist; Applies to food

  • Can be eaten with a fork or spoon
  • Could be eaten with chopsticks in some cases
  • Soft and moist with no separate thin liquids
  • Small lumps visible within the food
  • Adults: 4mm lump size
  • Lumps are easy to squash with the tongue

6 (six), blue; soft & Bite-sized; Applies to food

  • 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 loading a fork or spoon
  • Chewing is required before swallowing
  • Soft, tender and moist throughout but with no separate thin liquids
  • ‘Bite-sized’ pieces as appropriate for size and oral processing skills
  • Adult: 15mm=1.5cm pieces

7 (seven), black; Easy to Chew/Regular; Applies to food

  • 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 soft
  • Bite size is not restricted at Level 7
  • Adults: smaller or greater than 15mm = 1.5 cm pieces
  • Includes hard, tough, chewy, fibrous, stringy, dry, crispy, crunchy, or crumbly bits
  • Includes food that contains pips, seeds, pith inside skin, husks or bones
  • Includes “dual consistency” or mixed consistency” foods and liquids.

Not all IDDSI drink thicknesses need to be used at the facility level. There is no expectation that every facility would use all five levels. Also, there is no expectation that every facility will use all five levels of food texture modification. Some long-term care facilities may only use Level 7- Regular, Level 6 – Soft and Bite sized, and Level 4 – Puree/Extremely Thick.

Become familiar with the IDDSI website and resources at: https://iddsi.org/. It is important to create a ‘workplace wide’ multidisciplinary IDDSI team that includes Food Service, Dietitian, Speech Therapist, Clinical Team/Health Care providers and all others affected by IDDSI implementation.

 

References:

https://iddsi.org/