Feeding a Child with Swallowing Difficulty (Dysphagia): Food and Fluid Modifications

What is food/fluid consistency modification?

Food and drink consistency

Types of food consistency

Feeding a child with swallowing difficulty (dysphagia) may require the parent or caregiver to modify food/fluid consistency to ensure safe swallowing.

What is food/fluid consistency modification?

It is a compensatory strategy to ensure swallowing is safe (i.e. reduce aspiration risk) when feeding a child with feeding and/or swallowing difficulties (dysphagia).

This information is intended for general information. Please consult your speech therapist for specific advice.

Food and drinks consistency are classified using the IDDSI (International Dysphagia Diet Standardisation Initiative) classification system.

Food and drink consistency

Level	Description
0 Thin	Flows like water Can flow through a straw or teat/nipple
1 Slightly Thick	Is thicker than water Can flow through a straw, teat/nipple
2 Mildly Thick	Is sippable Pours quickly from a spoon but slower than 'Thin' drinks and 'Slightly Thick' drinks Needs some effort to drink using a standard straw
3 Moderately Thick	Can be drunk from a cup or taken with a spoon Needs some effort to drink through a wide diameter straw and cannot be sucked through an infant teat/nipple Has a smooth texture with no lumps, fibers or seeds
4 Extremely Thick	Is usually eaten with a spoon Cannot be drunk from a cup or sucked through a straw or infant teat/nipple Does not require chewing Has a smooth texture with no lumps Holds shape on a spoon Is not sticky

Flow tests are used to ensure that accurate modifications made to achieve desired thickness of fluid.

Types of food consistency

Level	Description
3 Liquidised	Can be eaten with a spoon or drunk from a cup Cannot be eaten with a fork because it drips through the fork prongs Has a smooth texture with no lumps
4 Pureed	Is usually eaten with a spoon Does not require chewing Has a smooth texture with no lumps Holds shape on a spoon Falls off a spoon in a single spoonful when tilted Is NOT sticky Liquid must not separate from solids
5 Minced and Moist	Soft and moist, but NO liquid leaking/dripping from food Biting is not required Minimal chewing is required Has lumps of 2mm in size, can be mashed with tongue Food can be mashed with just a little pressure from a fork Should be able to scoop food onto a fork with no liquid dripping and no crumbles falling off fork
6 Soft and Bite-sized	Soft, tender and moist, but with no thin liquid leaking/dropping from the food Does not require the ability to bite off a piece of food However, ability to chew bite-sized pieces is required Bite-sized pieces should be no larger than 8mm x 8mm Food can be mashed/broken down with pressure from fork A knife is not required to cut this food
7 Easy to Chew/Regular	Normal, everyday foods Any method can be used to eat these foods (e.g. using fingers, a fork, a spoon, chopsticks etc) Food consists of a range of sizes, appropriate for the child’s age and level of development