Dysphagia

Question 1

What is the IDDSI framework?

Answer 1

Levels of food textures and drink thickness to improve safety for those with swallowing difficulties.

7- Regular
6 - Soft and bite-sized
5 - Minced and moist
4 - Pureed food/ extremely thick liquid
3 - Liquidised food/ moderately thick liquid
2 - Mildly thick
1 - Slightly thick
0 - Thin

Question 2

What is level 4 - IDDSI
Who is it recommended for?

Answer 2

Pureed food/ extremely thick liquid
- Does not require chewing
- Can be piped, eaten with fork or spoon
- Too thick to drink from cup or straw
- Falls off spoon, holds it shape
- Not sticky

If tongue control is significantly reduced, no chewing required, good for missing teeth/ poorly fitting dentures

Question 3

What is level 5 - IDDSI
Who is it recommended for?

Answer 3

Minced and moist
- Can be eaten with fork, chopsticks of spoon
- Not sticky or dry
- No separate liquid
- Size of lumps 2x8mm paeds, 4x15mm adult

No biting, minimal chewing, good for those who have fatigue with lots of chewing, for patients with some tongue control as this moves the bolus, good for missing teeth/ poorly fitting dentures

Question 4

What is level 7 - IDDSI
Who is it recommended for?

Answer 4

Regular - easy to chew
- Everyday foods with soft and tender textures
- Any method to eat these foods
- A range of sizes
- No hard, tough, chewy, fibrous, stringy textures

For patients who can chew and swallow (may need supervision) for those who find hard and tough foods difficult to eat

Question 5

What is level 3 - IDDSI
Who is it recommended for?

Answer 5

Liquidised food/ moderately thick liquid

Allows time for oral control, for those with pain on swallowing and requires some tongue propulsion

Question 6

What is level 6 - IDDSI
Who is it recommended for?

Answer 6

Soft and bite sized
- Can be eaten with a fork, chopsticks or spoon
- Soft, tender and moist with no separate liquid
- Chewing is required
- Bite sized pieces (8mm paeds & 15mm adult

Food pieces minimise choking, tongue force and control is needed, good for missing teeth/ poorly fitting dentures

Question 7

What is level 2 - IDDSI
Who is it recommended for?

Answer 7

Mildly thick liquid
- Pours quickly off a spoon
- Mild effort is required to drink

Suitable if tongue is slightly reduced

Question 8

What are the advantages and disadvantages of having an NG tube?

Answer 8

Advantages:
- Easy to remove
- No need for sedation
- Less invasive and safer insertion than a PEG
- Can receive complete nutrition without having to eat

Disadvantages:
- Can be uncomfortable
- Can fall out so may need to be replaced
- Patient’s don’t like aesthetic of location
- Some risk of aspiration
- Require upright sleeping position if running overnight

Question 9

What textures pose risk to choking?

Answer 9

• Hard
• Dry
• Tough
• Chewy
• Crispy
• Crunchy
• Sharp
• Spiky
• Crumbly
• Pips, seeds
• Skins, husks, outer shells

Question 10

What are transitional food?
Who are they recommended for?

Answer 10

They change texture when moisture is added, or if there is a change in temperature
The tongue should be able to break up these foods once the change has occurred

• These foods might be used for developmental teaching, or rehabilitation of the swallow.