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Level 4 Extremely Thick Liquids for AdultsWhat is this thickness level?Level 4 – Extremely Thick drinks:ü Are usually eaten with a spoonü Cannot be drunk from a cup or suckedthrough a strawü Do not require chewingü Have a smooth texture with no lumpsü Hold shape on a spoonü Fall off a spoon in a single spoonful when tiltedü Are not stickyWhy is this thickness level used for adults?Level 4 - Extremely Thick drinks may be used if your tongue control is not good enough to manageModerately Thick, Mildly Thick, Slightly Thick or Thin drinks. Extremely Thick drinks allows more time forthe tongue to “hold and move” the liquid. It’s important that Extremely Thick drinks are not too stickybecause this can cause the food to stick to the cheeks, teeth, roof of the mouth or in the throat. ExtremelyThick drinks are best taken using a spoon.How do I measure my liquid or drink to make sure it is Level 4 Extremely thick?It is safest to measure Extremely Thick drinks using the IDDSI Fork Drip Test and the IDDSI Spoon Tilt Test.See videos of the IDDSI Fork Drip Test and IDDSI Spoon Tilt Test remely thick liquids sit in amound or pile above the forkIDDSI Spoon Tilt TestSample holds its shape onthe spoon and falls offfairly easily if the spoon istilted or lightly flickedIDDSI Fork Drip TestLiquid does not dollop,or drip continuously throughthe fork prongsA small amountmay flowthrough andform a tailbelow the forkSample should not befirm or stickyExtremely Thick drink or liquid mustpass both tests!Intended for general information only. Please consult with your health care professional for specific advice for your needs

Level 4 Pureed Food for AdultsWhat is this food texture level?Level 4 – Pureed Foods:ü Are usually eaten with a spoonü Do not require chewingü Have a smooth texture with no lumpsü Hold shape on a spoonü Fall off a spoon in a single spoonful when tiltedü Are not stickyü Liquid (like sauces) must not separate from solidsWhy is this food texture level used for adults?Level 4 – Pureed Food may be used if you are not able to bite or chew food or if your tongue control isreduced. Pureed foods only need the tongue to be able to move forward and back to bring the food tothe back of the mouth for swallowing.It’s important that puree 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. Pureed foods are best eaten using a spoon.How do I test my food to make sure it is Level 4 Pureed?It is safest to test Pureed Food using the IDDSI Fork Drip Test and the IDDSI Spoon Tilt Test.See videos of the IDDSI Fork Drip Test and IDDSI Spoon Tilt Test remely thick liquids sit in amound or pile above the forkIDDSI Spoon Tilt TestSample holds its shape onthe spoon and falls offfairly easily if the spoon istilted or lightly flickedIDDSI Fork Drip TestLiquid does not dollop,or drip continuously throughthe fork prongsA small amountmay flowthrough andform a tailbelow the forkSample should not befirm or stickyPureed food must pass both tests!Intended for general information onlyPlease consult with your health care professional for specific advice for your needs

For safety, AVOID these food textures that pose a choking risk for adultswho need Level 4 Pureed foodFood characteristic toAVOIDExamples of foods to AVOIDMixed thin thick texturesHard or dry foodSoup with pieces of food, cereal with milkNuts, raw vegetables (e.g. carrot, cauliflower, broccoli), dry cakes,bread, dry cerealSteak, pineappleTough or fibrous foodsLollies/candies/sweets, cheese chunks, marshmallows, chewingChewygum, sticky mashed potato, dried fruits, sticky foodsCrackling, crisp bacon, cornflakesCrispyRaw carrot, raw apple, popcornCrunchy foodCorn chips and crispsSharp or spikyDry cake crumble, dry biscuitsCrumbly bitsApple seeds, pumpkin seeds, white of an orangePips, seedsPeas, grapes, chicken skin, salmon skin, sausage skinFood with skins or outer shellCorn, shredded wheat, branFoods with husksChicken bones, fish bones, other bones, meat with gristleBone or gristleSausage, grapeRound, long shaped foodNut butter; overcooked oatmeal/porridge, edible gelatin, konjacSticky or gummy foodcontaining jelly, sticky rice cakesBeans, rhubarbStringy foodLettuce, cucumber, uncooked baby spinach leavesFloppy foodsCrust formed during cooking or Crust or skin that forms on food during cooking or after heating,for example, cheese topping, mashed potatoheatingLettuce, cucumber, baby spinach leaves‘Floppy’ foodWhere juice separates from the food piece in the mouth, for‘Juicy’ foodexample watermelonLumps in pureed food or yoghurtVisible lumpsExtra Clinician notesIntended for general information only. Please consult with your health care professional for specific advice for your needs

Level 5 Minced & Moist Food for AdultsWhat is this food texture level?Level 5 – Minced & Moist Foods:ü Soft and moist, but with no liquid leaking/dripping fromthe foodü Biting is not requiredü Minimal chewing requiredü Lumps of 4mm in sizeü Lumps can be mashed with the tongueü Food can be easily mashed with just a little pressure from a forkü Should be able to scoop food onto a fork, with no liquid dripping and no crumblesfalling off the forkWhy is this food texture level used for adults?Level 5 – Minced & Moist food may be used if you are not able to bite off pieces of food safely but havesome basic chewing ability. Some people may be able to bite off a large piece of food, but are not ableto chew it down into little pieces that are safe to swallow. Minced & Moist foods only need a smallamount of chewing and for the tongue to ‘collect’ the food into a ball and bring it to the back of themouth for swallowing. It’s important that Minced & Moist foods are not too sticky because this cancause the food to stick to the cheeks, teeth, roof of the mouth or in the throat. These foods are eatenusing a spoon or fork.How do I test my food to make sure it is Level 5 Minced & Moist?It is safest to test Minced & Moist food using the IDDSI Fork Drip Test and the IDDSI Spoon Tilt Test.See videos of the IDDSI Fork Test and IDDSI Spoon Tilt Test SI Spoon Tilt TestSample holds its shape onthe spoon and falls off fairlyeasily if the spoon is tiltedor lightly flickedIDDSI Fork TestFor adults the lump sizeis 4mm, which is aboutthe gap between theprongs of a standarddinner forkSample should not be firmor stickyMinced & Moist food mustpass both tests!Intended for general information onlyPlease consult with your health care professional for specific advice for your needs

EXAMPLES of Level 5 Minced & Moist Food for Adults*******Meat served finely minced or chopped to 4mm lump sizeserved in a thick, smooth, non-pouring sauce or gravyFish served finely mashed or chopped to 4mm lump sizeserved in a thick, smooth, non-pouring sauce or gravyFruit served finely mashed or use a blender to finely chop itinto to 4mm lump size pieces (drain any excess liquid)Vegetables cooked, finely mashed or use a blender tofinely chop it into to 4mm lump size pieces (drain any excessliquid)Cereal served thick with small soft 4mm lumps. Anymilk/fluid should not separate from the cereal. Drain anyexcess liquid before servingRice requires a sauce to moisten it and hold it together. Riceshould not be sticky or gluey and should not separate intoindividual grains when cooked and served. May require a thick,smooth, non-pouring sauce to moisten and hold the ricetogetherNO REGULAR DRY BREAD due to high choking risk!See CvIqHA/featured?reload 9for instructions on how to make a Level 5 Minced & Moist sandwichSee videos of the IDDSI Fork Test and IDDSI Spoon Tilt Test SI Spoon Tilt TestIDDSI Fork TestFor adults the lump sizeis 4mm, which is aboutthe gap between theprongs of a standarddinner forkMinced & Moist food mustpass both tests!Sample holds its shape onthe spoon and falls off fairlyeasily if the spoon is tiltedor lightly flickedSample should not be firmor stickyIntended for general information onlyPlease consult with your health care professional for specific advice for your needs

For safety, AVOID these food textures that pose a choking risk for adultswho need Level 5 Minced & Moist FoodFood characteristic toAVOIDExamples of foods to AVOIDMixed thin thick texturesHard or dry foodSoup with pieces of food, cereal with milkNuts, raw vegetables (e.g. carrot, cauliflower, broccoli), dry cakes,bread, dry cerealSteak, pineappleTough or fibrous foodsLollies/candies/sweets, cheese chunks, marshmallows, chewingChewygum, sticky mashed potato, dried fruits, sticky foodsCrackling; crisp bacon, cornflakesCrispyRaw carrot, raw apple, popcornCrunchy foodCorn chips and crispsSharp or spikyDry cake crumble, dry biscuitsCrumbly bitsApple seeds, pumpkin seeds, white of orangePips, seedsPeas, grapes, chicken skin, salmon skin, sausage skinFood with skins or outer shellCorn, shredded wheat, branFoods with husksChicken bones, fish bones, other bones, meat with gristleBone or gristleSausage, grapeRound, long shaped foodNut butter, overcooked oatmeal/porridge, edible gelatin, konjacSticky or gummy foodcontaining jelly, sticky rice cakesBeans, rhubarbStringy foodLettuce, cucumber, uncooked baby spinach leavesFloppy foodsCrust formed during cooking or Crust or skin that forms on food during cooking or after heating,for example cheese topping, mashed potatoheatingLettuce, cucumber, baby spinach leaves‘Floppy’ foodWhere juice separates from the food piece in the mouth, for‘Juicy’ foodexample watermelonCasserole pieces larger than 4mmx4mmx15mm; fruit, vegetable,Large or hard lumps of foodmeat or other food pieces larger than 4mmx4mmx15mmExtra Clinician notesIntended for general information only. Please consult with your health care professional for specific advice for your needs

Level 6 Soft & Bite-Sized for AdultsWhat is this food texture level?Level 6 – Soft & Bite-Sized Foods:ü Soft, tender and moist, but with no thin liquid leaking/drippingfrom the foodü Ability to ‘bite off’ a piece of food is not requiredü Ability to chew ‘bite-sized’ pieces so that they are safe toswallow is requiredü ‘Bite-sized’ pieces no bigger than 1.5cm x 1.5cm in sizeü Food can be mashed/broken down with pressure from forkü A knife is not required to cut this foodWhy is this food texture level used for adults?Level 6 – Soft & Bite-Sized food may be used if you are not able to bite off pieces of food safely but areable to chew bite-sized pieces down into little pieces that are safe to swallow. Soft & Bite-Sized foodsneed a moderate amount of chewing, for the tongue to ‘collect’ the food into a ball and bring it to theback of the mouth for swallowing. The pieces are ‘bite-sized’ to reduce choking risk. If you notice the foodpieces are not being chewed well though, please contact your clinician to make sure you are on thecorrect food texture to reduce choking risk. Soft & Bite-Sized foods are eaten using a fork, spoon orchopsticks.How do I test my food to make sure it is Level 6 Soft & Bite-Sized?It is safest to test Soft & Bite-Sized food using the IDDSI Fork Pressure test.See videos of the IDDSI Fork Pressure Test SI Fork Pressure TestFor adults the lump size is no bigger than 1.5cm x1.5cm, which is about the width of a standard dinnerfork.To make sure the food is soft enough, press down onthe fork until the thumbnail blanches to white, then liftthe fork to see that the food is completely squashedand does not regain its shapeNo bigger than1.5cmm x 1.5cm bite sizefor adultsSoft & Bite-Sized foodmust pass bothsize and softness tests!Intended for general information only. Please consult with your health care professional for specific advice for your needs

EXAMPLES of Level 6 Soft & Bite-Sized Food for Adults*******Meat cooked tender and chopped so pieces are no biggerthan 1.5cmx1.5cm lump size. If cannot serve soft and tender,serve as Minced and MoistFish cooked soft enough to break and serve in pieces nobigger than 1.5cmx1.5cmFruit soft and chopped to pieces no bigger than1.5cmx1.5cm pieces (drain any excess liquid). Do not usethe fibrous parts of fruit (for example, the white parts ofan orange). Be extra careful if you are eating fruit with a highwater content, where the juice separates from the solid in the mouth duringchewing (for instance, fruits like watermelon or other melons)Vegetables steamed or boiled with final cooked size no bigger than 1.5cmx1.5cm. (Stir friedvegetables are too firm and are not suitable)Cereal served with pieces no bigger than 1.5cmx1.5cm, with their texture fully softened. Drainexcess liquid before servingNO REGULAR DRY BREAD due to high choking risk! vIGCvIqHA/featured?reload 9for instructions on how to make a Level 5 Minced & Moist sandwich, as this is also suitable for use onSoft & Bite-Sized dietRice requires a sauce to moisten it and hold it together. Rice should not be sticky or gluey and shouldnot separate into individual grains when cooked and served. May require a thick, smooth, nonpouring sauce to moisten and hold the rice togetherSee videos of the IDDSI Fork Pressure Test SI Fork Pressure TestFor adults the lump size is no bigger than 1.5cm x1.5cm, which is about the width of a standard dinnerfork.To make sure the food is soft enough, press down onthe fork until the thumbnail blanches to white, then liftthe fork to see that the food is completely squashedand does not regain its shapeNo bigger than1.5cmm x 1.5cm bite sizefor adultsSoft & Bite-Sized foodmust pass bothsize and softness tests!Intended for general information only. Please consult with your health care professional for specific advice for your needs

For safety, AVOID these food textures that pose a choking risk for adultswho need Level 6 Soft & Bite-Sized FoodFood characteristic toAVOIDExamples of foods to AVOIDMixed thin thick texturesHard or dry foodSoup with pieces of food, cereal with milkNuts, raw vegetables (e.g. carrot, cauliflower, broccoli); drycakes, bread, dry cerealSteak; pineappleTough or fibrous foodsLollies/candies/sweets, cheese chunks, marshmallows, chewingChewygum, sticky mashed potato, dried fruits, sticky foodsCrackling, crisp bacon, cornflakesCrispyRaw carrot, raw apple, popcornCrunchy foodCorn chips and crispsSharp or spikyDry cake crumble, dry biscuits (add sauce to make these suitable)Crumbly bitsApple seeds, pumpkin seeds, white of orangePips, seedsPeas, grapes, chicken skin, salmon skin, sausage skinFood with skins or outer shellCorn, shredded wheat, branFoods with husksChicken bones, fish bones, other bones, meat with gristleBone or gristleSausage, grapeRound, long shaped foodNut butter, overcooked oatmeal/porridge, edible gelatin, konjacSticky or gummy foodcontaining jelly, sticky rice cakesBeans, rhubarbStringy foodLettuce, cucumber, uncooked baby spinach leavesFloppy foodsCrust formed during cooking or Crust or skin that forms on food during cooking or after heating,for example, cheese topping; mashed potatoheatingLettuce, cucumber, baby spinach leaves‘Floppy’ foodWhere juice separates from the food piece in the mouth, for‘Juicy’ foodexample watermelonCasserole pieces larger than 1.5cmx1.5cm, fruit, vegetable, meat,Large or hard lumps of foodpasta or other food pieces larger than 1.5cmx1.5cmExtra Clinician notesIntended for general information only. Please consult with your health care professional for specific advice for your needs

REGULAREASY TO CHEWLevel 7 Regular Easy to Chew for AdultsWhat is this food texture level?Level 7 – Regular Easy to Chew Foods:ü Normal, everyday foods* of soft/tender textureü Any method may be used to eat these foods (e.g.fingers, fork, spoon, chopsticks etc.)ü Food piece size is not restricted in Level 7, thereforefoods may be a range of sizes. Food pieces can besmaller or bigger than 1.5cm x 1.5cmü Do not use foods that are: hard, tough, chewy,fibrous, have stringy textures, pips/seeds, bonesor gristleü You should be able to ‘bite off’ pieces of soft and tenderfood and choose bite-sizes that are safe to chew and swallowü You should be able to chew pieces of soft and tender food, so they are safe toswallow without tiring easilyü Your tongue should be able to move food for chewing and apply pressure until the food is soft andmoist enough to be easily swallowedü You should be able to remove bone, gristle or other hard pieces that cannot be swallowed safelyfrom your mouth without help or direction from others*May include ‘mixed thin and thick texture’ food and liquids together – ask your clinician for direction onthis.Why is this food texture level used for adults?Level 7 – Regular Easy to Chew food may be used if you have strong enough chewing ability to breakdown soft/tender foods into pieces without help, you have no increased risk of choking and do not haveswallowing problems. This texture may be right for you if you usually choose to eat soft food, haveweaker chewing muscles for hard/firm textures, but can chew soft and tender food without tiring easily. Itmay also be a good choice if you have been sick and are recovering strength. Your clinician mightrecommend this texture if they are teaching you advanced chewing skills.Who should not have this texture level?This level is not intended for people where there is an identified increased risk of choking. People who areunsafe to eat without supervision are not considered suitable for this texture level. People can be unsafeto eat without supervision because of chewing and swallowing problems and/or unsafe mealtimebehaviours. Examples of unsafe mealtime behaviours include: not chewing very much, putting too muchfood into the mouth, eating too fast or swallowing large mouthfuls of food. Always consult with your healthprofessional for specific advice for your needs, requests and requirements for supervision. *Wheremealtime supervision is needed, this level should only be used under the strict recommendation andwritten guidance of a qualified health professional.Intended for general information only. Please consult with your health care professional for specific advice for your needs

Serve food as normal. If you notice the food pieces are not being chewed well enough, please contact yourclinician to make sure you are on the correct food texture. See local guidelines for what to do in case ofchoking.How do I test my food to make sure it is Level 7 Regular Easy to Chew?Foods should be able to be cut or broken apart with the side of a fork or spoon. It is then safest to testRegular Easy to Chew food using the IDDSI Fork Pressure test.See videos of the IDDSI Fork Pressure Test SI Fork Pressure TestMust be able to breakfood apart easily withthe side of a fork orspoonEasy to Chew foodsmust break ap

Some handouts have only one page and others have 3 or 4 pages. The table below provides a list of the handouts and the number of pages for each handout. Consumer handouts for adults . have a swallowing problem with liquids. Water, milk, tea, coffee, and juice are all examples of the Level 0 Thin thickness level. Thin liquids can be taken .