A quick-reference guide for busy clinicians, caregivers, and food-service teams
The International Dysphagia Diet Standardisation Initiative (IDDSI™) was developed to replace the National Dysphagia Diet and create one global, evidence-based language for food and drink consistencies. A single framework eliminates the “Mechanical Soft vs. Dysphagia Soft” guessing game that so often puts our patients at risk.
At-a-Glance: IDDSI™ Levels
| Drink Levels | Description | IDDSI Flow Test |
|---|---|---|
| Level 0 – Thin | Flows like water | ≤ 1 ml left after 10 s |
| Level 1 – Slightly Thick | Thicker than water (e.g., many formulas, Boost®, Ensure®) | 1–4 ml left |
| Level 2 – Mildly Thick | Former “nectar thick”; pours easily, but with visible body | 4–8 ml left |
| Level 3 – Moderately Thick | Former “honey thick”; sippable from a cup, heavy through a straw | 8–10 ml left |
| Level 4 – Extremely Thick / Purée | Former “pudding thick”; eaten with a spoon, no lumps or separation | 10 ml left |
| Food Levels | Description | Key Tests |
|---|---|---|
| Level 3 – Liquidised | Smooth, pourable meal replacements; no bits; cannot hold its shape | Fork: drip ≤ 8 ml; Spoon: coats & pours |
| Level 4 – Puréed | Spoon-able mound, no chewing; falls off spoon in one plop | Fork drip: none; Spoon tilt: slides cleanly |
| Level 5 – Minced & Moist | Tiny, moist lumps (≤ 4 mm × 15 mm); minimal chewing | Fork pressure: thumbnail doesn’t blanch |
| Level 6 – Soft & Bite-Sized | Bite-sized (≤ 15 mm) pieces; chewing required but no knife | Fork pressure: thumbnail blanches |
| Level 7 – Easy to Chew | Everyday soft foods; no size limit; cutting/biting required | Fork/Spoon: breaks without springing back |
| Level 7 – Regular | No texture restrictions | — |
Transitional Foods
Items that change texture quickly in the mouth (e.g., ice chips, sherbet, shortbread, certain crisps and wafers). Use the Fork/Spoon + 1 ml water test: the item should crumble or melt within 1 minute under gentle pressure.
Why the Tests Matter
The syringe flow, fork pressure, and spoon tilt tests make IDDSI™ objective—no more subjective “pudding-like” descriptions. Consistency across disciplines and facilities means safer meals, fewer errors, and better patient outcomes.
Ready-Made Resources
- Printable Level Sheets & Testing Cards – ideal for staff training
- Posters, Patient Handouts & Multilingual Guides – support global implementation
- Evidence Summaries & Peer-Reviewed Articles – stay up to date
- Facility Roll-Out Toolkits – step-by-step implementation help
All resources are free at IDDSI.org → Resources.
Quick Links
- Everything IDDSI™ Framework: https://iddsi.org/framework
- Download Implementation Guides: IDDSI.org → Resources → Implementation
- Evidence Base: IDDSI.org → Resources → Evidence
- Multilingual Documentation: IDDSI.org → Resources → Translations
© The International Dysphagia Diet Standardisation Initiative 2019 – https://iddsi.org/framework
Licensed under the Creative Commons Attribution-ShareAlike 4.0 License (https://creativecommons.org/licenses/by-sa/4.0/legalcode). Derivative works extending beyond language translation are not permitted.
Supplementary Notice: Modifying the diagrams or descriptors within the IDDSI™ Framework is strongly discouraged. Alterations may cause confusion and have been linked to adverse events—including choking and death—due to incorrect texture or drink selection.
Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!
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