International Dysphagia Diet Standardization

Level 0- Thin Flows like water
Can flow through a straw
Examples:
Water, milk, tea, coffee, and Juice<br>

Level 1- Slightly Thick Thicker than water
Can Flow through a straw
Some drinks are naturally thick: certain fruit nectars or milks
Other liquids need to be thickened: milk, tea, coffee, juice<br>

Level 2- Mildly Thick Are “Sippable”
Pour quickly from a spoon but slower than think drinks and slightly thick drinks
Need some effort to drink this thickness using a standard straw
Some milkshakes and thick shakes may be at this thickness level but other beverages need to be thickened<br>

Level 3- Moderately Thick Liquid and Liquidised Food Moderately Thick Liquids
Can be drunk from a cup or taken with a spoon
Need effort to drink through a wide diameter straw
Smooth texture with no lumps, fibers, or seeds<br>

Level 3- Moderately Thick Liquid and Liquidized Food Liquidized Food
Eaten with a spoon or drunk from a cup
Cannot be eaten with a fork (drips through prongs)
Smooth texture with no ”bits (fibers, lumps, shell or skin)<br>

Level 4- Extremely Thick Liquids and Pureed Foods Previously known as: Dysphagia Pureed Level 1
Eaten with a spoon, does not require chewing, cannot be drunk from a cup or sucked through a straw
Have a smooth texture with no lumps, hold shape on spoon
Fall off spoonful in a single spoonful when tilted, not sticky
Important that the food is not too sticky because it can stick to cheeks, teeth, and roof of veteran
Liquid (like sauces) must not separate from solids Must Pass Both Tests!<br>

Level 5- Minced and Moist Previously known as: Dysphagia Mechanically Altered Level 2
Soft and moist, with no liquid leaking/dripping from the food
Biting not required, minimal chewing required
Lumps size of 4mm that can be mashed with tongue
Food can be easily mashed with little pressure form fork
Should be able to scoop food onto a fork, with no liquid dripping and no crumbles falling off the fork Must Pass Both Tests!<br>

What Foods are okay on a Level 5 Diet? Meat and fish served minced or chopped to 4 mm lump size, served in thick, smooth, noon-pouring sauce or gravy
Fruit and vegetables (cooked) finely mashed or chopped in a blender to 4 mm size (drain excess liquid)
Hot cereal served tick with small, soft 4 mm lumps (drain excess liquid)
Rice with thick sauce to moisten and hold together Mixed Textures: Hard cereal with milk
Hard or Dry food: Nuts, Raw vegetables, Dry bread
Crispy: bacon
Sharp: Corn Chips
Seeds: apple, pumpkin, whites of an orange
Foods with husk: corn, shredded wheat, bran
Round, long shaped: sausage, grape
Sticky: nut butter, overcooked oatmeal
Stringy: beans, rhubarb
Floppy: lettuce, cucumber, baby spinach leaves
Juicy: juice separates from the food, watermelon<br>

Level 6- Soft and Bite Sized Previously known as: Dysphagia Advanced Level 3
Soft, tender and moist, but with no thin liquid leaking from food
Not required: ability ‘bite off’ a piece of food
Required: ability to chew ‘bit-sized’ pieces so they are safe to swallow
Food can be mashed/broken down with pressure from a fork
Knife not required to cut food<br>

What Foods are okay on a Level 6 Diet? Meat cooked tender and chopped to bite size pieces
Fish cooked soft enough to break and serve in bite size pieces
Fruit soft and chopped to bite sized pieces, drain extra liquid; avoid fibrous parts of fruit like the white parts of an orange
Vegetables steamed or boiled soft and cut into bite sized pieces
Cereal served in bite sized pieces with texture fully softened, extra liquid drained
Rice with thick sauce to moisten and hold together Mixed Textures: Hard cereal with milk
Hard or Dry food: Nuts, Raw vegetables, Dry bread
Crispy: bacon
Sharp: Corn Chips
Seeds: apple, pumpkin, whites of an orange
Foods with husk: corn, shredded wheat, bran
Round, long shaped: sausage, grape
Sticky: nut butter, overcooked oatmeal
Stringy: beans, rhubarb
Floppy: lettuce, cucumber, baby spinach leaves
Juicy: juice separates from the food, watermelon<br>

Level 7- Easy to Chew Normal foods of soft/tender texture
Any method can be used to eat these foods (fingers, fork, spoon)
Food piece size not restricted
Do not use: hard, tough, chewy, fibrous, stringy textures, seeds, bones<br>

What Foods are okay on a Level 7 Diet? Meat cooked tender
Fish cooked soft enough to break apart easily
Fruit that are soft enough to break apart with side of fork or spoon, drain liquid and remove fibrous parts
Vegetables that are steamed or boiled until tender
Cereal served with texture softened, extra liquid drained
Rice, cooked regularly Hard or Dry food: Nuts, Raw vegetables, Dry bread, dry cereal
Tough or fibrous: steak, pineapple
Chewy: candies, cheese chunks, marshmallows, dried fruits
Crispy: bacon
Sharp: Corn Chips
Seeds: apple, pumpkin, whites of an orange
Bones: in chicken, fish, or meat
Sticky: edible gelatin, sticky rice cakes
Stringy: beans, rhubarb<br>

Level 7- Regular Normal, everyday foods of various textures that are developmentally and age appropriate
Ability to ‘bite off’ foods required
Chewing ability required for soft and hard foods
May include ‘mixed consistency’ foods (cereal with milk or soup with vegetable pieces)<br>