Feeding a Child with Swallowing Difficulty (Dysphagia): Food and Fluid Modifications
KK Women’s and Children’s Hospital (KKH) Paediatric Neurology and Speech Therapy departments share how to modify consistency when preparing food for a child with swallowing difficulties (dysphagia).
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
0 Thin | |
1 Slightly Thick | |
2 Mildly Thick | |
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
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
|
Ref: K21
