What Is IDDSI? A Beginner's Guide to the Framework

Why a Shared Language Matters

Before IDDSI, a "soft diet" meant different things in different hospitals, care homes, and countries. A patient discharged from hospital with instructions to eat "minced food" might receive something completely different at the next facility — a dangerous inconsistency for anyone with swallowing difficulties. The IDDSI framework, published in 2015 and revised in 2019, solves this by defining eight numbered levels with objective tests.

IDDSI is now adopted across more than 40 countries and is the reference standard cited in Hong Kong's T/SATA 094-2025 care food specification. Understanding it is the first step for any caregiver, dietitian, or food supplier working in the dysphagia space.

The 8 IDDSI Levels Explained

IDDSI splits into two overlapping scales — one for drinks (Levels 0–4) and one for foods (Levels 3–7). The overlap at Levels 3 and 4 reflects that a very thick drink and a very thin puree behave similarly.

Level 0 — Thin: Ordinary water, juice, milk, tea. Flows freely through a 10 mL syringe in under 10 seconds. Safe only for people with no swallowing impairment.

Level 1 — Slightly Thick: Slightly thicker than water; coats a spoon lightly. Still flows freely but is marginally slower, giving a person with mild delayed swallow reflex a fraction more time.

Level 2 — Mildly Thick: Pours like cream. Flows through a syringe in 1–4 mL remaining after 10 seconds. Recommended for early-stage dysphagia.

Level 3 — Liquidised / Moderately Thick: Can be drunk from a cup or eaten with a spoon. Smooth and lump-free. A fork pressed in leaves a clear impression. Used for people who cannot chew but can manage a smooth flow.

Level 4 — Puréed / Extremely Thick: Holds its shape briefly on a spoon. Does not flow or drip. Can be moulded. Falls off a spoon in a single mound. This is the level most commonly produced with SeniorDeli's food gellant and moulding products. See our [food gellant guide](/blog/food-gellant-guide) for preparation tips.

Level 5 — Minced & Moist: Soft, moist, and in small particles no larger than 4 mm. Can be mashed with the tongue. Requires some tongue control but no chewing. See our [IDDSI Level 4 standards post](/blog/iddsi-level-4-standards) for a comparison.

Level 6 — Soft & Bite-Sized: Tender pieces up to 15 mm. Can be crushed with the tongue alone with minimal chewing. Suitable for people with mild dysphagia and some remaining chewing ability.

Level 7 — Regular / Easy to Chew: Ordinary food with normal textures. May include soft versions of regular meals for people who tire easily but have no significant swallowing impairment.

How to Verify a Food's IDDSI Level

IDDSI provides three simple tests any caregiver can perform at home:

Fork pressure test (Levels 3–7): Press the flat side of a fork firmly onto the food. If it squashes easily and holds the fork marks, it is soft enough. If it springs back or won't squash, it is too firm for the intended level.

Spoon tilt test (Level 4): Scoop a spoonful and tilt the spoon sideways. The food should slide off in one mound and hold its shape on the plate — not flow or leave trails.

Syringe flow test (Levels 0–2): Draw 10 mL of liquid into a standard 10 mL slip-tip syringe. Hold vertically for 10 seconds. Measure how much has flowed out.

These tests take under a minute and remove guesswork. SeniorDeli's [tutorials page](/tutorials) includes video demonstrations.

Choosing the Right Level for Your Loved One

Level assignment should always come from a speech-language therapist (SLT) following a clinical swallowing assessment. Never change a person's prescribed IDDSI level based on appearance alone — silent aspiration (food entering the airway without coughing) is a real risk. If you do not yet have an SLT assessment, the [EAT-10 self-screening tool](/assessment) on this site can help you identify warning signs to discuss with a doctor.

Once a level is assigned, SeniorDeli's range of products — [Clear Thickener](/products/clear-thickener), [Food Gellant](/products/food-gellant), [Cold Gellant](/products/cold-gellant), and [Food Softener](/products/food-softener) — make it practical to prepare safe, nutritious, and dignified meals at every level. Browse our [standards page](/standards) for the full Hong Kong regulatory context.

Citations

IDDSI Framework (2019). Complete IDDSI Framework. iddsi.org/framework. Accessed 2025. Cichero, J.A.Y. et al. (2017). Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management. Dysphagia, 32(2), 293–314. T/SATA 094-2025, Group Standard for Dysphagia Care Food Products, Hong Kong.