December 2017

IDDSI extends our very best wishes to everyone for this holiday season!

  • IDDSI Food Testing Methods
  • IDDSi Levels 3, 4, 5 and 6
  • IDDSI Around the World
  • Translations
  • Special Celebrations and #IDDSIChallenge
  • IDDSI on the Move
IDDSI Food Testing Methods
TESTING, TESTING, TESTING…… using the IDDSI Food Testing methods.

Is that minced and moist foods really minced and moist enough for swallowing with minimal chewing?  What about that piece of food – will it break down easily in the mouth with some chewing and tongue movement? 

There are so many foods and different ways to prepare food; how can I be sure that the food being eaten by the person with dysphagia is the right texture and consistency?

These were the challenging questions that encouraged the IDDSI board of directors to develop testing methods using common and accessible tools (spoon, fork, chopsticks or fingers) to ensure that foods being offered were the correct recommended texture and consistency.

Foods have various characteristics –hardness, moisture content, particle size etc.  To meet the criteria for the various IDDSI Food Levels – it is essential to use ALL the recommended testing methods to ensure the various aspects such as size, moisture, ability to break down under pressure, are met.
IDDSI Level 6 Soft & Bite sized foods
  • In order to meet the criteria for this level, food pieces must be the correct size (1.5 x 1.5 cm adults, 0.8 cm pediatrics).
  • Food must also be tested to see how easily it will break down under pressure. 
  • There are no separate thin liquids with food at this level
  • Use the Fork or Spoon pressure test, the Chopstick test or the finger test to determine this.
  • Chewing ability is needed for this texture level, although biting ability is not required.
IDDSI Level 5 Minced and Moist foods
  • Particle size, softness, as well as moisture level are key characteristics for this level. 
  • It is therefore important to check particle size using the fork pressure test to ensure particles are soft enough to separate and come through the tines of the fork (4mm –adults, 2mm pediatrics). 
  • Use the Fork Drip Test to check if it is too runny (also no separate thin liquids at his level)
  • Use the Spoon Tilt Test to check if it is too sticky. 
  • Alternatively, the Chopstick and Finger tests can also be used.
  • Minimal chewing should be needed for this texture level (tongue force should be able to squash or break the food).
IDDSI Level 4 Puree foods/extremely thick (liquids)
  • Moisture content is important – (to avoid too sticky or too runny)
  • No lumps
  • Use the Fork pressure test – check for lumps and consistency
  • Use the Fork Drip test to check if too runny
  • Use the Spoon Tilt test to check if too sticky.
  • Alternatively, the Finger test can also be used but the chopstick test is not suitable.
  • No biting or chewing, and no bolus formation skills are required.
IDDSI Level 3 Liquidised /moderately thick (liquids)
  • Can be drunk from a cup but not eaten by fork
  • Use the IDDSI Flow test – 8-10 mls remains in syringe after 10 seconds flow (see IDDSI Flow Test for details
  • Use the Fork Drip Test and Spoon Tilt Test
  • Alternatively, the Finger test but not the Chopstick test can be used.
Where in the World is IDDSI?
Apparently everywhere! The IDDSI Board is excited to find many peer-reviewed scientific studies being published and referring to IDDSI. Check it out in Google Scholar.
IDDSI Translations: Can you help?
Check out our final translations on the website:
  • French (Canada)
  • Norwegian
  • Swahili
  • Farsi
  • Italian

Check out our website and if you speak any of these languages, please consider providing feedback on the current draft documents up for review:

Can you help? Consider reviewing a translated document and providing comments or email us if you are interested in translating documents.    Click here to read instructions on how you can help.
SPECIAL CELEBRATIONS – including everyone #IDDSIChallenge
  • Special celebrations often include cherished traditional foods and drinks. 
  • Take a moment to think about all those who experience eating, drinking and swallowing difficulties – how easy is it for them to fully partake in these celebrations?
  • Our IDDSI challenge to you – how can these special cherished foods and drinks be modified so EVERYONE can enjoy them together?? We’d love to see and hear your ideas! Please email us or tweet at us with the hashtag #IDDSIChallenge with recipes and/or photos.
IDDSI on the Move
2018 is looking to be a busy year already for the IDDSI Board of Directors with presentation planned at a number of conferences around the world:
  • December 2017, Chinese Nutrition and Health Food Association, Taizhou, China.
  • December 2017, Dysphagia event- Fresenius-Kabi, Belfast, Northern Ireland
  • January 2018, Dysphagia event- Fresenius-Kabi, Dublin, Ireland
  • January 2018, UK Dysphagia Symposium, RCSLT, NHS, Academy of Medical Royal Colleges, London, UK
  • February 2018, UK Swallowing Research Group (UKSRG), London UK
  • April 2018. Brazilian Dysphagia Conference, Brazil
  • April 2018 – Ontario AdvantAge Conference – Toronto, ON, Canada
  • May 2018, Dietitians Association of Australia National Conference, Sydney, Australia,
  • May 2018, Speech Pathology Australia National Conference, Adelaide, Australia,May 2018 – Nourishing Knowledge - Optimizing Nutrition in Continuing Care – Red Deer, AB, Canada
  • June 2018 – Canadian Society of Nutrition Management Conference – Moncton, NB, Canada
Connect with us on Twitter below & let us know your thoughts!
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. Email us at