August 2018

  • IDDSI Testing Methods
  • Use of IDDSI Resources
  • Color Codes
  • 10ml syringe updates
  • More FAQs answered
  • Translations updates
  • Webinar Series
  • IDDSI on the Move
The science behind the IDDSI food and drink testing methods.
Foods and drinks have deliciously complex and interesting structures but that makes them very difficult to categorize. Everyone has their own individual ideas of what they consider “thick” or “soft” might mean, or what they might “look like”. In scientific laboratories there are machines which can be used to measure specific aspects of drink thickness and food texture, but the equipment is expensive and not available to clinicians, food services and consumers. Even in scientific labs there is not one standard test which can be used to define consistency for all foods & drinks

In developing the IDDSI framework, the IDDSI board mapped physiology to textural properties and then selected and adapted practical measurements to add specific measures to define the 8 IDDSI Levels. 

The key aspects of these measures were that:
  1. Tests were accurate,
  2. Equipment was inexpensive and available to everyone,
  3. Food or drink can be tested anywhere, including the point of serving.

Drink measurement
The flow test of liquid consistency is based on funnels used in the food and chemicals industry. We adapted this concept to use a commonly-available, inexpensive “funnel” which can be formed by removing the plunger from a syringe, then setting a time limit of 10 seconds and volume of 10 ml to minimize time and wastage. The resulting test gives a scale from 0-10 which maps the full range of consistency from watery liquids to semi-solids (IDDSI Levels 0-3). 

Food measurement
Testing foods is more complex as there are many important characteristics such as moistness, stickiness, hardness and toughness which are not straightforward to assess even in a laboratory. The concept of “fork mash-able” has been used in the past, but this depends on individual hand strength and judgement. We introduced the concept of thumbnail blanching pressure to provide a more-consistent definition of pressure without having to resort to mechanical tools or motors. The spoon-tilt and fork-drip tests are practical measures of adhesiveness and cohesiveness respectively, designed to be used at the point of serving and can be performed very quickly with minimal training required.

We  strongly recommend using the IDDSI testing methods , rather than relying on the less accurate methods of pictures, descriptions or lists of food and drinks, to ensure those with swallowing or choking risk are provided with the required food or drinks.
IMPORTANT: Use of IDDSI Logo and Resources
Recently, we have received a number of correspondences inquiring about the use of the IDDSI Logo and reproducing IDDSI resources in other publications or in materials produced by industry, businesses or professional organizations. IDDSI users have informed us that there have been some materials for sale or made available for free which include the IDDSI logo and are misleading to think that these are ‘official’ IDDSI resources/products. Some of these materials have used outdated information and others have incorrect information.  

We respectfully ask that the IDDSI logo does not get included on any materials other than materials officially produced as IDDSI resources . IDDSI has product labelling guidelines for industry partners and we would ask businesses and organisations to follow the same guidelines.  Access Labelling Guidelines here.

IDDSI  does not endorse, certify, credential or provide stamps of approval for any merchandise, organisational resources, training materials or programs which have not been officially included in the IDDSI resources section of our website.  

When using IDDSI resources, please note that some of the materials are  copyrighted (e.g. flow test cards, food test cards). These cards are intended to be printed and used as they are and not to be modified into other formats as they have been scaled to precise measures. 

All IDDSI resources are licensed under the CreativeCommons Attribution Sharealike 4.0 Licence Attribution is requested as follows:

(c) The International Dysphagia Diet Standardisation Initiative 2016 @  Attribution is NOT PERMITTED for derivative works incorporating any alterations to the IDDSI Framework that extend beyond language translation.

If the IDDSI Framework or descriptors are used, please  cite the above attribution andalways include as the source. Because the work of IDDSI is dynamic, materials and resources on the website may be updated and modified.  We will always endeavor to inform all IDDSI users of updates in our e-bite newsletters or on the homepage of our website.

Please check the IDDSI website for the most current information and resources.
Having trouble accessing our website resources? Some tips:
  • Download and use our free IDDSI app instead. It works on iOS and Android platforms.
  • Try clearing the CACHE in your browser
  • Speak with your IT support team.
Colour Codes
We have recently refreshed our colour code charts to enable everyone to have consistent colours for our IDDSI resources and improve visibility.

Our framework was developed with 3 different identifiers:
  1. The use of numbers,
  2. Descriptive text; and
  3. The use of colours. 

The colours were selected ensuring that these would meet the needs of those with colour blindness but also avoid confusion with other common colours used in health care. 

While we do provide colour codes, consider using Pantone solid colour codes for print applications which are not only universal but are also consistent.

Remember you can Download Colour Codes and labels for IDDSI levels from our Resource centre .
10ml Syringes - Update for Europe
IDDSI has been receiving many questions regarding how to obtain the correct sized 10 syringe in the UK and Europe.  We are aware that currently, 10 ml syringes of the correct size are difficult to obtain in the UK and Europe.  

IDDSI is working hard on finding a longer term solution.  In the interim, if you live in the UK or Europe, we recommend you contact your thickener representative regarding obtaining syringes .

Syringes and IDDSI Flow test cards will be available at ESSD 2018 conference in Dublin, IE and EFAD 2018 conference in Rotterdam, NL. 
Can I use the IDDSI testing methods for testing foods and drinks used for the radiological swallow study (MBS, VFSS)?
Yes, the use of IDDSI testing methods is recommended to help confirm the consistency or texture and to be able to show your patient or family how to achieve the correct consistency at home using the same IDDSI testing methods.

In some countries, commercial contrast products of different thicknesses may be available (example Varibar™).Clinicians may be interested in Dr. Catriona Steele’s work in mapping Varibar to the IDDSI framework using the IDDSI flow test.

Want to hear more about this topic? Sign up for our upcoming webinars.
New Webinar Announced
September 18 & 19, 2018

Title: Using the IDDSI Flow test in clinical practice: How thick is thick and does thickness really matter?

Presenter:  Carly Babon is a speech-language pathologist and PhD candidate in the Swallowing Rehabilitation Research Laboratoryin Toronto Canada. 

This webinar will help health professionals fine tune their skills in using the IDDSI Flow test to measure liquids provided in health care settings, including the use of flow test with contrast agents used in radiological swallow studies.  Carly will also illustrate how to help patients with dysphagia map their own dietary requirements for home using the IDDSI flow test.
Upcoming Webinars and Recordings

October 16 & 29, 2018 (Registration will open soon)

Title:  Myths & Truths about Modifying Foods for IDDSI Levels

Presenters:   Preston Walker & James Ball 

Preston and James have been developing ideas in healthcare catering for over 10 years. Their collaboration has led to the establishment of Oak House Kitchen, based at Preston's family residential home in Greetham, England. Oak House Kitchen aims to improve the practical application of nutrition across many different diet restrictions. For many years they have been training chefs, care workers and healthcare professionals in how best to modify foods for dysphagia. Their current focus in this field is on the transition to the IDDSI standards and have been working on how best to achieve this.

In this cooking-based webinar, Preston and James will show you how to modify foods to the IDDSI standards. They will show you a range of practical solutions to common problems across various foods. You will see that foods modified for dysphagia can be delicious, nutritious and look great!

If you missed any of our previous webinars – you can still watch them at our YouTube channel.
IDDSI Translations: Greek
The Greek translation of the IDDSI documents is ready for peer-review! Thank you to our volunteers for their hard work.

We now have an easier online-based translation feedback form.

Please take a moment and see if a language you are fluent in is available for review. Your comments, thoughts and suggestions are always appreciated!

Check out our Translations tab.
IDDSI on the Move
  • Aug/Sept 2018 – Dietitians New Zealand Conference, Auckland, NZ
  • Sept 2018 – New Zealand Speech-Language Therapists Association Conference, Dunedin, NZ
  • September 2018 – Invited speaker for IDDSI Yokohama, Japan and Hiroshima, Japan
  • September 2018 – European Federation of the Associations of Dietitians Conference, Rotterdam, NL
  • October 2018 – Keynote address on IDDSI at the Biomouth Conference, University of Canterbury, Christchurch, NZ
  • October 2018 – Pediatric Dysphagia Series Conference, Cincinnati, OH, USA
  • October 2018 – Academy of Nutrition & Dietetics Food & Nutrition Conference & Expo, Washington, DC, USA
  • October 2018 – Institute of Hospitality in Healthcare, Sydney, Australia
  • November 2018 – American Speech-Language-Hearing Association convention, Boston, MA, USA
  • November 2018 – Iowa AND Conference, West Des Moines, IA, USA

Please let us know what you are doing in your part of the world. We would be happy to share it with the rest of the world.
Connect with us on social media & let us know your thoughts!