IDDSI in 2019? Hard for RDN's to Swallow - Sue Linja, RDN, LD - S&S Nutrition Network, Inc
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IDDSI in 2019? Hard for RDN’s to Swallow Sue Linja, RDN, LD - S&S Nutrition Network, Inc
Hospital
Expert
Clinical Scared
or FNS
Director
We’ll
Never
Get There
Speech
Language
Pathologist
What the heck
Audience Today? is IDDSI?
Assisted Attended RD
Living or 3 or More
Home Trainings
Care First Timer
Optimistic
SNF
To Succeed, Jump as Quickly at Opportunities as You Do at Conclusions ~Benjamin Franklin
IDDSI is for
Swallowing
Difficulties
Not
Dentition You kept me up all night grinding your gums!
Dental Soft Diet or Level 7 - Regular Easy to Chew
For Swallow Dysfunction
Colors Numbers Names
• Black • White
•7 • Regular
• Blue •6 • Soft & Bite Sized
• Orange •5 • • Minced & Moist
• Green • 4 • Puree (Extensively Thick)
• Yellow •3 • Moderately Thick
(Liquidized)
• Magenta •2 • Mildly Thick
• Gray •1 • Slightly Thick
• White •0 •
• Thin
Thin
IDDSI Criteria
Food Pieces
Liquid
& Shapes
Thick
ness
Dual Textures: Food
Food
Liquid Must Not Texture:
Moisture:
Separate Softness,
Hardness,
Tenderness,
Dryness
Mashability
IDDSI FOOD & DRINKS CLASSIFICATION AND TESTING
International Dysphagia Diet
Standardisation Initiative ADULT & PEDIATRIC
Food that starts as a firm solid texture and changes to another texture
when it becomes wet or when warmed. Minimal chewing ability needed.
TRANSITIONAL FOODS TEST INSTRUCTIONS
TESTING INFO
FOODS 1. 10 2. Thumbnail
Add 1mL Then complete blanches
of water to the IDDSI Fork white
LEVEL 7 - REGULAR RG7 Normal everyday foods of various textures that are developmentally
S
1.5cm x 1.5cm Pressure Test.
and age appropriate. Biting and chewing ability needed. sample and
D
No specific testing information.
wait 1 minute.
O
Normal everyday foods of soft/tender textures only, that are
EC7
O
LEVEL 7 - EASY TO CHEW developmentally and age appropriate.
Requires biting and chewing ability.
F
FLOW TEST INSTRUCTIONS
LEVEL 6 - SOFT & BITE-SIZED SB6
L
Soft + Bite-sized, tender and moist throughout, with 10
A
10 10 10
Pieces no bigger than 1.5 x 1.5cm in size for
adults and 8mm x 8mm for babies & children. no thin liquid leaking or dripping from the food.
N
Push down on piece with fork – sample should Chewing ability needed. !
IO
10
squash completely and not regain its shape.
1. 2. 3. 4.
IT
Remove Cover Release Stop
LEVEL 5 - MINCED & MOIST MM5 Plunger nozzle nozzle at 10
S
4mm lump size for adults and 2mm lump size for with finger & start seconds
Very soft, small moist lumps, minimal
N
babies and children. and fill 10ml timer
chewing ability needed.
A
Holds its shape on a spoon. Falls off easily if the spoon is
R
tilted or lightly flicked. Must not be firm or sticky. TESTING INFO
T
LEVEL 4 - PUREED PU4 LEVEL 4 - EXTREMELY THICK EX4
Sits in a mound or pile above the fork. Does not dollop Smooth with no lumps, not sticky, Sits in a mound or pile above the fork.
or drip continuously through a fork. no chewing ability needed. Does not dollop or drip continuously through a fork.
Holds its shape on a spoon.
Holds its shape on a spoon. Falls off easily if the spoon Can be eaten with a spoon. Falls off easily if the spoon is tilted or lightly flicked.
is tilted or lightly flicked. Must not be firm or sticky. Must not be firm or sticky.
LEVEL 3 - LIQUIDISED LQ3 Can be eaten with a spoon or drunk LEVEL 3 - MODERATELY THICK MO3
from a cup. Cannot be eaten with a
No less than 8mL remaining in the syringe after 10 sec of flow. fork because it slowly drips through. No less than 8mL remaining in the syringe after 10 sec of flow.
Drips slowly in dollops through the prongs of a fork. Effort needed to drink this through a
wide straw. Drips slowly in dollops through the prongs of a fork.
FOOD TEST INSTRUCTIONS LEVEL 2 - MILDLY THICK MT2
'Sippable' from a cup but effort
PUREED needed to drink this through a 4-8mL remaining in the syringe after 10 sec of flow.
standard straw/teat/nipple.
EXTREMELY
THICK
LEVEL 1 - SLIGHTLY THICK ST1
ADULT Thicker than water. Can flow through a standard
MINCED & 4mm 1-4mL remaining in the syringe after 10 sec of flow.
CHILD straw/teat/nipple.
MOIST 2mm
Thumbnail LEVEL 0 - THIN TN0
SOFT & blanches
white Flows like water. Flows easily through any straw/teat/nipple.
BITE-SIZED Less than 1 mL remaining in the
syringe after 10 sec of flow.
Thumbnail
blanches
EASY TO
CHEW
white
DRINKS / LIQUIDS © IDDSI 2019
www.iddsi.org
Liquids - Easy Transition
Recommendation
For Consistency….
Use Pre-thickened
Beverages
Whenever PossibleFocus on Levels 6, 5 & 4
Tools of the Trade
9/16th inch - Same as 15 mm
and slightly more than 1/2 inch
IDDSI
International Dysphagia Diet
Standardisation InitiativeLevel 6 Soft & Bite-Sized for Adults
For safety, AVOID these food textures that pose a choking risk for adults
What is this food texture level?
who need Level 6 Soft & Bite-Sized Food
Level 6 – Soft & Bite-Sized Foods:
ü Soft, tender and moist, but with no thin liquid leaking/dripping Food characteristic to Examples of foods to AVOID
from the food AVOID
ü Ability to ‘bite off’ a piece of food is not required
ü Ability to chew ‘bite-sized’ pieces so that they are safe to Mixed thin + thick textures Soup with pieces of food, cereal with milk
swallow is required Hard or dry food Nuts, raw vegetables (e.g. carrot, cauliflower, broccoli); dry
ü ‘Bite-sized’ pieces no bigger than 1.5cm x 1.5cm in size cakes, bread, dry cereal
ü Food can be mashed/broken down with pressure from fork Tough or fibrous foods Steak; pineapple
ü A knife is not required to cut this food
Chewy Lollies/candies/sweets, cheese chunks, marshmallows, chewing
Why is this food texture level used for adults? gum, sticky mashed potato, dried fruits, sticky foods
Level 6 – Soft & Bite-Sized food may be used if you are not able to bite off pieces of food safely but are Crispy Crackling, crisp bacon, cornflakes
able to chew bite-sized pieces down into little pieces that are safe to swallow. Soft & Bite-Sized foods Crunchy food Raw carrot, raw apple, popcorn
need a moderate amount of chewing, for the tongue to ‘collect’ the food into a ball and bring it to the Sharp or spiky Corn chips and crisps
back of the mouth for swallowing. The pieces are ‘bite-sized’ to reduce choking risk. If you notice the food Crumbly bits Dry cake crumble, dry biscuits (add sauce to make these suitable)
pieces are not being chewed well though, please contact your clinician to make sure you are on the Pips, seeds Apple seeds, pumpkin seeds, white of orange
correct food texture to reduce choking risk. Soft & Bite-Sized foods are eaten using a fork, spoon or
Food with skins or outer shell Peas, grapes, chicken skin, salmon skin, sausage skin
chopsticks.
Foods with husks Corn, shredded wheat, bran
How do I test my food to make sure it is Level 6 Soft & Bite-Sized? Bone or gristle Chicken bones, fish bones, other bones, meat with gristle
It is safest to test Soft & Bite-Sized food using the IDDSI Fork Pressure test.
Round, long shaped food Sausage, grape
Sticky or gummy food Nut butter, overcooked oatmeal/porridge, edible gelatin, konjac
See videos of the IDDSI Fork Pressure Test at containing jelly, sticky rice cakes
www.IDDSI.org/framework/food-testing-methods/ EXAMPLES of Level 6 Soft & Bite-Sized Food for Adults Stringy food Beans, rhubarb
Floppy foods Lettuce, cucumber, uncooked baby spinach leaves
No bigger than * Meat cooked tender and chopped so pieces are no bigger Crust formed during cooking or Crust or skin that forms on food during cooking or after heating,
IDDSI Fork Pressure Test 1.5cmm x 1.5cm bite size than 1.5cmx1.5cm lump size. If cannot serve soft and tender,
for adults heating for example, cheese topping; mashed potato
For adults the lump size is no bigger than 1.5cm x serve as Minced and Moist
‘Floppy’ food Lettuce, cucumber, baby spinach leaves
1.5cm, which is about the width of a standard dinner * Fish cooked soft enough to break and serve in pieces no ‘Juicy’ food Where juice separates from the food piece in the mouth, for
fork. bigger than 1.5cmx1.5cm example watermelon
To make sure the food is soft enough, press down on * Fruit soft and chopped to pieces no bigger than Large or hard lumps of food Casserole pieces larger than 1.5cmx1.5cm, fruit, vegetable, meat,
the fork until the thumbnail blanches to white, then lift 1.5cmx1.5cm pieces (drain any excess liquid). Do not use pasta or other food pieces larger than 1.5cmx1.5cm
the fork to see that the food is completely squashed the fibrous parts of fruit (for example, the white parts of Extra Clinician notes
and does not regain its shape Soft & Bite-Sized food an orange). Be extra careful if you are eating fruit with a high
must pass both water content, where the juice separates from the solid in the mouth during
size and softness tests! chewing (for instance, fruits like watermelon or other melons)
Intended for general information only. Please consult with your health care professional for specific advice for your needs * Vegetables steamed or boiled with final cooked size no bigger than 1.5cmx1.5cm. (Stir fried Intended for general information only. Please consult with your health care professional for specific advice for your needs
vegetables are too firm and are not suitable)
* Cereal served with pieces no bigger than 1.5cmx1.5cm, with their texture fully softened. Drain
excess liquid before serving
* NO REGULAR DRY BREAD due to high choking risk! See
https://www.youtube.com/channel/UC0I9FDjwJR0L5svIGCvIqHA/featured?reload=9
for instructions on how to make a Level 5 Minced & Moist sandwich, as this is also suitable for use on
Soft & Bite-Sized diet
* Rice requires a sauce to moisten it and hold it together. Rice should not be sticky or gluey and should
not separate into individual grains when cooked and served. May require a thick, smooth, non-
pouring sauce to moisten and hold the rice together
See videos of the IDDSI Fork Pressure Test at
www.IDDSI.org/framework/food-testing-methods/
No bigger than
IDDSI Fork Pressure Test 1.5cmm x 1.5cm bite size
for adults
For adults the lump size is no bigger than 1.5cm x
1.5cm, which is about the width of a standard dinner
fork.
To make sure the food is soft enough, press down on
the fork until the thumbnail blanches to white, then lift
the fork to see that the food is completely squashed
and does not regain its shape Soft & Bite-Sized food
must pass both
size and softness tests!
Intended for general information only. Please consult with your health care professional for specific advice for your needsAudit Tool
Testing intended for
Product or food tested
Heating method(s)
Temperature when tested at: time of service 15 mins after serving 30 mins after serving
Instructions:
• Level 6 Soft & Bite-Sized critical tests include Appearance + Fork/Spoon Pressure Test OR if these are not available Finger Test.
• For particle size: food intended to mimic a ‘bite of food’ – must be equal to or less than 15mm x15mm (adults); equal to or less than 8mm x 8mm (pediatrics).
• The food item must pass or meet criteria for any row marked *.
Tests Meets criteria at
Time of service 15 mins 30 mins
Critical: Appearance after serving after serving
* Pieces less than or equal to 15mm x 15mm (adults); 8mm x 8mm (pediatrics) Yes No Yes No Yes No
* No separate thin liquid Yes No Yes No Yes No
Critical: Fork/Spoon Pressure Test (metal dinner fork or teaspoon needed)
* When pushing down on a 15mm x 15mm sample with a dinner fork or teaspoon, with enough pressure Yes No Yes No Yes No
that the thumb nail turns white, the food can be squashed and will not return to original shape
* Food can be separated into smaller pieces using pressure from a dinner fork or teaspoon held on its Yes No Yes No Yes No
side
Alternative if Fork or Spoon not available: Finger Test
* When pushing down on a 15mm x 15mm sample using thumb, with enough pressure that the thumb Yes No Yes No Yes No
nail turns white, the food can be squashed and will not return to original shape
* Food feels moist Yes No Yes No Yes No
Optional: Chopstick Test
Chopsticks can break 15mm x 15mm pieces into smaller pieces Yes No Yes No Yes No
OVERALL CONCLUSION: Does the sample meet the criteria for Level 6 Soft & Bite-sized? Yes No Yes No Yes No
Notes: * Chewing ability is needed for this texture, although biting is not required. Pieces should be ‘bite-sized’ at time of serving.
* Please see also http://iddsi.org/framework/food-testing-methods/Demonstration
1/8th inch -
Same as 4 mm
IDDSI
International Dysphagia Diet
Standardisation Initiative
https://www.youtube.com/watch?v=9tMowfeuzVYLevel 5 Minced & Moist Food for Adults For safety, AVOID these food textures that pose a choking risk for adults
What is this food texture level? who need Level 5 Minced & Moist Food
Level 5 – Minced & Moist Foods:
ü Soft and moist, but with no liquid leaking/dripping from Food characteristic to Examples of foods to AVOID
the food AVOID
ü Biting is not required
ü Minimal chewing required Mixed thin + thick textures Soup with pieces of food, cereal with milk
ü Lumps of 4mm in size Hard or dry food Nuts, raw vegetables (e.g. carrot, cauliflower, broccoli), dry cakes,
ü Lumps can be mashed with the tongue bread, dry cereal
ü Food can be easily mashed with just a little pressure from a fork Tough or fibrous foods Steak, pineapple
ü Should be able to scoop food onto a fork, with no liquid dripping and no crumbles Chewy Lollies/candies/sweets, cheese chunks, marshmallows, chewing
falling off the fork gum, sticky mashed potato, dried fruits, sticky foods
Crispy Crackling; crisp bacon, cornflakes
Why is this food texture level used for adults? Crunchy food Raw carrot, raw apple, popcorn
Level 5 – Minced & Moist food may be used if you are not able to bite off pieces of food safely but have Sharp or spiky Corn chips and crisps
some basic chewing ability. Some people may be able to bite off a large piece of food, but are not able Crumbly bits Dry cake crumble, dry biscuits
to chew it down into little pieces that are safe to swallow. Minced & Moist foods only need a small
Pips, seeds Apple seeds, pumpkin seeds, white of orange
amount of chewing and for the tongue to ‘collect’ the food into a ball and bring it to the back of the
Food with skins or outer shell Peas, grapes, chicken skin, salmon skin, sausage skin
mouth for swallowing. It’s important that Minced & Moist foods are not too sticky because this can
cause the food to stick to the cheeks, teeth, roof of the mouth or in the throat. These foods are eaten Foods with husks Corn, shredded wheat, bran
using a spoon or fork. Bone or gristle Chicken bones, fish bones, other bones, meat with gristle
Round, long shaped food Sausage, grape
Sticky or gummy food Nut butter, overcooked oatmeal/porridge, edible gelatin, konjac
How do I test my food to make sure it is Level 5 Minced & Moist?
containing jelly, sticky rice cakes
It is safest to test Minced & Moist food using the IDDSI Fork Drip Test and the IDDSI Spoon Tilt Test.
Stringy food Beans, rhubarb
Floppy foods Lettuce, cucumber, uncooked baby spinach leaves
See videos of the IDDSI Fork Test and IDDSI Spoon Tilt Test at EXAMPLES of Level 5 Minced & Moist Food for Adults Crust formed during cooking or Crust or skin that forms on food during cooking or after heating,
www.IDDSI.org/framework/food-testing-methods/ heating for example cheese topping, mashed potato
‘Floppy’ food Lettuce, cucumber, baby spinach leaves
* Meat served finely minced or chopped to 4mm lump size
served in a thick, smooth, non-pouring sauce or gravy ‘Juicy’ food Where juice separates from the food piece in the mouth, for
IDDSI Spoon Tilt Test
* Fish served finely mashed or chopped to 4mm lump size example watermelon
Sample holds its shape on
the spoon and falls off fairly served in a thick, smooth, non-pouring sauce or gravy Large or hard lumps of food Casserole pieces larger than 4mmx4mmx15mm; fruit, vegetable,
easily if the spoon is tilted * Fruit served finely mashed or use a blender to finely chop it meat or other food pieces larger than 4mmx4mmx15mm
IDDSI Fork Test
For adults the lump size
or lightly flicked into to 4mm lump size pieces (drain any excess liquid) Extra Clinician notes
is 4mm, which is about * Vegetables cooked, finely mashed or use a blender to
Sample should not be firm finely chop it into to 4mm lump size pieces (drain any excess
the gap between the
or sticky liquid)
prongs of a standard
dinner fork Minced & Moist food must * Cereal served thick with small soft 4mm lumps. Any
pass both tests! milk/fluid should not separate from the cereal. Drain any
Intended for general information only excess liquid before serving Intended for general information only. Please consult with your health care professional for specific advice for your needs
Please consult with your health care professional for specific advice for your needs
* Rice requires a sauce to moisten it and hold it together. Rice
should not be sticky or gluey and should not separate into
individual grains when cooked and served. May require a thick,
smooth, non-pouring sauce to moisten and hold the rice
together
* NO REGULAR DRY BREAD due to high choking risk!
See https://www.youtube.com/channel/UC0I9FDjwJR0L5svIGCvIqHA/featured?reload=9
for instructions on how to make a Level 5 Minced & Moist sandwich
See videos of the IDDSI Fork Test and IDDSI Spoon Tilt Test at
www.IDDSI.org/framework/food-testing-methods/
IDDSI Spoon Tilt Test
Sample holds its shape on
IDDSI Fork Test the spoon and falls off fairly
For adults the lump size easily if the spoon is tilted
is 4mm, which is about or lightly flicked
the gap between the Sample should not be firm
or sticky
prongs of a standard Minced & Moist food must
dinner fork pass both tests!
Intended for general information only
Please consult with your health care professional for specific advice for your needsAudit Tool
Testing intended for
Product or food tested
Heating method(s)
Temperature when tested: ☐ at time of service ☐ 15 mins after serving ☐ 30 mins after serving
Instructions:
• Level 5 Minced & Moist critical tests include Appearance + Fork Pressure Test + Spoon Tilt Test OR if these are not available Finger Test.
• For particle size: food intended to mimic a ‘chewed bolus’ – must be equal to or less than 4mm width and no longer than 15mm in length (adults);
Equal to or less than 2mm width and no longer than 8mm length (pediatrics).
• The food item must pass or meet criteria for any row marked ∗.
Tests Meets criteria at
Time of service 15 mins 30 mins
Critical: Appearance after serving after serving
∗ Lumps less than or equal to 4mm (adults); 2mm (pediatrics) Yes No Yes No Yes No
∗ No separate thin liquid Yes No Yes No Yes No
Critical: Fork Pressure Test (metal dinner fork needed)
∗ Food can be easily mashed with little pressure from a dinner fork Yes No Yes No Yes No
[pressure should not make thumb nail blanch to white]
∗ Easily separates and comes through prongs of a dinner fork Yes No Yes No Yes No
Critical: Spoon Tilt Test (teaspoon needed)
∗ Holds shape on teaspoon Yes No Yes No Yes No
∗ Food slides off spoon with little food left on teaspoon (i.e. not sticky) Yes No Yes No Yes No
May spread or slump slowly on a flat plate Yes No Yes No Yes No
Alternative if Fork or Spoon not available: Finger Test
∗ Small soft smooth rounded particles can be easily squashed between fingers Yes No Yes No Yes No
∗ Food feels moist and will leave fingers wet Yes No Yes No Yes No
Optional: Chopstick Test
Chopsticks can scoop or hold this texture if food is moist and cohesive Yes No Yes No Yes No
OVERALL CONCLUSION: Does the sample meet the criteria for Level 5 Minced & Moist? Yes No Yes No Yes No
Notes: ∗ Minimal chewing should be needed to eat this food texture (e.g. tongue force should be able to squash/break food).
∗ Please see also http://iddsi.org/framework/food-testing-methods/Demonstration
https://youtu.be/EIItIGY3ndo
Level 4 Pureed Food for Adults For safety, AVOID these food textures that pose a choking risk for adults
who need Level 4 Pureed food
What is this food texture level?
Level 4 – Pureed Foods: Food characteristic to Examples of foods to AVOID
ü Are usually eaten with a spoon AVOID
ü Do not require chewing
Mixed thin + thick textures Soup with pieces of food, cereal with milk
ü Have a smooth texture with no lumps
Hard or dry food Nuts, raw vegetables (e.g. carrot, cauliflower, broccoli), dry cakes,
ü Hold shape on a spoon
bread, dry cereal
ü Fall off a spoon in a single spoonful when tilted
Tough or fibrous foods Steak, pineapple
ü Are not sticky
ü Liquid (like sauces) must not separate from solids Chewy Lollies/candies/sweets, cheese chunks, marshmallows, chewing
gum, sticky mashed potato, dried fruits, sticky foods
Why is this food texture level used for adults? Crispy Crackling, crisp bacon, cornflakes
Crunchy food Raw carrot, raw apple, popcorn
Level 4 – Pureed Food may be used if you are not able to bite or chew food or if your tongue control is
reduced. Pureed foods only need the tongue to be able to move forward and back to bring the food to Sharp or spiky Corn chips and crisps
the back of the mouth for swallowing. Crumbly bits Dry cake crumble, dry biscuits
Pips, seeds Apple seeds, pumpkin seeds, white of an orange
It’s important that puree foods are not too sticky because this can cause the food to stick to the cheeks, Food with skins or outer shell Peas, grapes, chicken skin, salmon skin, sausage skin
teeth, roof of the mouth or in the throat. Pureed foods are best eaten using a spoon. Foods with husks Corn, shredded wheat, bran
Bone or gristle Chicken bones, fish bones, other bones, meat with gristle
How do I test my food to make sure it is Level 4 Pureed?
Round, long shaped food Sausage, grape
It is safest to test Pureed Food using the IDDSI Fork Drip Test and the IDDSI Spoon Tilt Test.
Sticky or gummy food Nut butter; overcooked oatmeal/porridge, edible gelatin, konjac
See videos of the IDDSI Fork Drip Test and IDDSI Spoon Tilt Test at containing jelly, sticky rice cakes
www.IDDSI.org/framework/food-testing-methods/ Stringy food Beans, rhubarb
Floppy foods Lettuce, cucumber, uncooked baby spinach leaves
Extremely thick liquids sit in a
Crust formed during cooking or Crust or skin that forms on food during cooking or after heating,
mound or pile above the fork
heating for example, cheese topping, mashed potato
IDDSI Spoon Tilt Test
‘Floppy’ food Lettuce, cucumber, baby spinach leaves
Sample holds its shape on ‘Juicy’ food Where juice separates from the food piece in the mouth, for
the spoon and falls off example watermelon
fairly easily if the spoon is Visible lumps Lumps in pureed food or yoghurt
tilted or lightly flicked Extra Clinician notes
Sample should not be
A small amount firm or sticky
may flow
through and
IDDSI Fork Drip Test form a tail
Liquid does not dollop, Pureed food must pass both tests! Intended for general information only. Please consult with your health care professional for specific advice for your needs
below the fork
or drip continuously through
the fork prongs Intended for general information only
Please consult with your health care professional for specific advice for your needsAudit Tool
Intended for
Product or food tested
Heating method(s)
Temperature when tested at: ☐ time of service ☐ 15 mins after serving ☐ 30 mins after serving
Instructions:
• Level 4 Pureed critical tests include Appearance + Fork Drip Test + Spoon Tilt Test OR if these are not available Finger Test. Chopstick test not appropriate.
• The food item must pass or meet criteria for any row marked ∗.
Tests Meets criteria at
Time of service 15 mins 30 mins
Critical: Appearance after serving after serving
∗ No lumps Yes No Yes No Yes No
Critical: Fork Drip Test (metal dinner fork needed)
∗ Food sits in a mound above dinner fork (a small amount may form a tail below the dinner fork) Yes No Yes No Yes No
∗ Does not drip or flow continuously through dinner fork Yes No Yes No Yes No
Critical: Spoon Tilt Test (teaspoon needed)
∗ Holds shape on teaspoon Yes No Yes No Yes No
∗ Food slides off teaspoon with little food left on teaspoon (i.e. not sticky) Yes No Yes No Yes No
May spread or slump slowly on a flat plate Yes No Yes No Yes No
Alternative if Fork or Spoon not available: Finger Test
∗ Hold a sample on fingers without it dripping through continuously Yes No Yes No Yes No
∗ Food slides smoothly and easily between fingers Yes No Yes No Yes No
Food may leave noticeable residue on fingers but is not sticky Yes No Yes No Yes No
Preferred but not critical: Fork Pressure Test
Prongs of dinner fork make clear pattern on surface OR food briefly retains fork indentation marks Yes No Yes No Yes No
OVERALL CONCLUSION: Does the sample meet the criteria for Level 4 Pureed? Yes No Yes No Yes No
Notes: ∗ A puree needs to be able to be put in the mouth and swallowed whole. No chewing and no bolus formation skills should be needed to eat this consistency.
∗ If you can pick the sample up in your hands and could bite a piece of it (e.g. moulded puree), the sample is not a puree and poses a choking risk.
∗ Please see also http://iddsi.org/framework/food-testing-methods/Demonstration
Level 7
Regular
Level 6
Soft and Bite Sized
Level 5
Minced and Moist
Level 4
PureeIDDSI Levels
Transitional Foods
Mixed Consistencies
And Yes, Gelled Bread
• Think Slurried
• SLP may order “may
have regular bread”How Diets May Be Ordered
Implementation
• Community Efforts
• Menus
• Diet Manual
• Electronic Health
Record
• Copious trainingSpring/Summer 2018 Menu
Wednesday Week 1
The Menu
S and S Nutrition Network Approved by: Sue Linja, RD, LD
Kelly Dimond RD, LD
Soft, Bite Size Minced & Moist
Regular (RG7) Serving Temperature Dental Soft Temperature (SB6) Temperature (MM5) Temperature Pureed (PU4) Temperature RCS Temperature Renal Temperature 2 gm Na Temperature AHA/Cardiac Temperature Gluten Restricted Temperature Hi Cal/Fortified
No Lumps -
Fork prong size Mounds above
AM
SAMPLE MENUDiet Manual Update
Implementation • Check out EVERYTHING on IDDSI.org • Start the conversations • Internal and external workgroup • Local hospitals - SLP’s, RD’s and CDM’s • Monthly education/training • Follow the IDDSI implementation plans
Resources Resources Video Resources: Level 6 Soft - https://www.youtube.com/watch?v=luWigA1VgVc&feature=youtu.be Level 5 – Minced and Moist - https://www.youtube.com/watch? v=F3CzsxIGCsk&feature=youtu.be Level 4 – Pureed - https://www.youtube.com/watch?v=EIItIGY3ndo Level 3 – Moderately Thick - https://www.youtube.com/watch?v=SiFwiGgIPHA Level 2 – Mildly thick - https://www.youtube.com/watch?v=XBqi_i0LLHw&feature=youtu.be Level 1 – slightly thick - https://www.youtube.com/watch?v=xyvDubBGJQU&feature=youtu.be IDDSI Flow Test Instructions - https://www.youtube.com/watch?v=BhfJWu1ybbs&t=2s Transitional Foods – Cheetos - https://www.youtube.com/watch?v=2AinvRD-pyo Transitional Foods – Ice Cream - https://www.youtube.com/watch?v=IKG-KvROYYs
Resources
Download the
APP
————
IDDSIIdaho Grant More to Follow
What Texture is This?
What Texture Is This
What Texture is This?
sue@sandsnutrition.com
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