Dysphagia Advanced Replaced by Soft & Bite-Sized

By: Karen Sheffler

May 12, 2014

“Soft & Bite-Sized” Replaces

“Dysphagia Advanced Diet”

by Karen Sheffler, MS, CCC-SLP, BCS-S of SwallowStudy.com

Your Speech-Language Pathologist (SLP) and medical team may have recommended a Dysphagia Advanced Diet, a Soft Diet, or a Soft & Bite-Sized Diet. At this time healthcare professionals may not have fully adopted standardized labels to describe diets.

Please note:  “Dysphagia Advanced” is an old term from the old National Dysphagia Diet, which was an attempt at diet standardization in America in 2002. The standardization of diet frameworks has been updated globally by the International Dysphagia Diet Standardisation Initiative or IDDSI.org. The old label of “Dysphagia Advanced” roughly maps over to the new label of “Soft & Bite-Sized,” per IDDSI. There are important differences to note between Dysphagia Advanced and Soft & Bite-Sized:

  • Particle size requirement is now 1.5 cm to prevent choking risk. This is about the size of an adult thumbnail and ideally smaller than the adult trachea. You would want the pieces to fall through the trachea and not block the trachea (opening to the airway).
  • Foods need to pass the Fork Pressure Test, showing that the food is soft, moist and easily squashed with pressure by your thumb on a dinner fork, pressing into the food.
  • Avoid bread, as this is the most commonly choked on food item. Allowing bread on this diet will be per your evaluations by an SLP specializing in difficulty swallowing. For example, you could ask to have breads tested on your swallow study (e.g., imaging with X-ray or scoping with a thin camera).

Soft & Bite-Sized Diet Characteristics:

Overall, this category of food textures can be challenging, as it is the closest diet to just a fully regular diet without restrictions. Do not advance to this diet unless under the guidance of your SLP and medical team.

This diet has some basic diet modifications or restrictions to make foods easier and safer for you:

  • Avoid very hard, sticky, crumbly or crunchy foods. Foods like nuts, rice, corn, some beans and peas may roll into your throat or get stuck in your mouth, throat, and/or esophagus (food tube). These challenging textures should be reviewed with your SLP.
  • Foods should be soft and easy to chew.
  • Easily cut/broken/mashed with a fork, using the Fork Pressure Test noted above and per IDDSI.org. You should not need a knife to cut this food.
  • Helpful for people with poor dentition, but with a relatively intact chewing and swallowing function.
  • Small and bite-sized pieces to avoid the risk of choking. Small pieces (1.5 cm per IDDSI) are safer and easier to chew. No biting is required.
  • These pre-cut small pieces can also decrease your effort in having to cut-up the food yourself, especially if you have difficulty using a knife and a fork. Ask your Occupational Therapist for a rocker knife if you only have the use of one hand.

Overall, this diet may be good to reduce fatigue that may occur in trying to eat a full regular meal.

See all IDDSI Framework Testing Methods here.

Read more about NDD changing to IDDSI here.

See a list of IDDSI resources here. 


You can take a look at this old chart, based on the National Dysphagia Diet and a Dysphagia Advanced Diet, but please be aware that the Dysphagia Advanced Diet did not have the bite-size and bread restrictions. Therefore, please use the chart with caution and review the chart with your speech-language pathologist (SLP). Dysphagia Advanced diet OLD patient handout