IDDSI Resources

November 29, 2017


IDDSI revised the framework March 2019 to include the Easy To Chew Level 7


IDDSI Resources

complied by Karen Sheffler, MS, CCC-SLP, BCS-S of & IDDSI Champion

Changing the world to this new dysphagia diet global standard will be no simple feat. However, it is crucial that we set goals for our facilities now, as the implementation kick-off was May 1, 2019 in the USA, per the American Speech-Language and Hearing Association and the Academy of Nutrition and Dietitics. The process will be expected to take more than a year (or even two) after the May 1, 2019 date to proceed from an awareness phase to the preparation phase and finally to full adoption of the IDDSI Framework.

The safety of people with difficulty swallowing (dysphagia) depends on this standardization. In an effort to make IDDSI easily digestible (pun intended) and to make our transition smoother, I have created this IDDSI resource guide to help you navigate the website.

Start now with plugging into the IDDSI website to start your own learning, then begin raising awareness in your facility and forming a team. You can already start dual-labeling in your reports (use old diet terms along side new IDDSI names). Perform food testing and IDDSI Flow Tests on all your products and menu items at your facility. Check out my IDDSI Flow Test data here (on a range of thickened liquid products, supplements and even Lactulose liquid medication):’s IDDSI Flow Test Data 2017-2018.

The information and videos listed here are freely available, and the IDDSI publications have always been free and Open Access. It is the goal of IDDSI to make all learning materials free to aide the global implementation of this framework without the barrier of cost.


IDDSI Framework Evidence Statement:

New IDDSI Framework changes as of March 2019: Addition of EASY TO CHEW – LEVEL 7

Here is a brief description of Easy To Chew diet:

  • Soft, but not necessarily bite-sized. This diet was created due to extensive feedback that the dysphagia diets were too restrictive with the 1.5cm bite-size requirement of Soft & Bite-Sized Level 6. People felt there was too large of a jump between Soft & Bite-Sized and Regular.
  • Not designed to prevent choking as there is no particle size requirement as in Soft & Bite-Sized Level 6..
  • Normal everyday foods of soft/tender textures only, that are developmentally and age appropriate.
  • Requires biting & chewing ability.
  • Foods are naturally moist, and NOT: Hard, chewy, fibrous, stringy.
  • No seeds, bones, gristle.
  • For patients with some weakness and/or who tire easily.
  • Mixed consistencies may be okay.

IDDSI YouTube Channel


IDDSI Testing Methods document (liquid and food testing in this document):

IDDSI Flow Test Instructions:

IDDSI Flow Test poster

IDDSI – Level 0 is a Thin Liquid and all the liquid will flow out of the syringe in about 7 seconds. Flow test not needed.

IDDSI Flow Test – Level 1: Slightly Thick (new level)

IDDSI Flow Test – Level 2: Mildly Thick Liquid (Nectar thick liquid per NDD)

IDDSI Flow Test – Level 3: Moderately Thick Liquid (Honey thick liquid per NDD)

IDDSI Flow Test – Level 4: Extremely Thick Liquid (Pudding thick liquid per NDD)

IDDSI Flow Test Comparison of Levels 1-3


Using the IDDSI Flow test in clinical practice: How thick is thick and does thickness really matter? by Carly Barbon, PhD(C), SLP(C) Reg.CASLPO


from @SwallowRehab – Swallowing Rehabilitation Research Lab (Dr Catriona Steele’s Lab):

Barbon, C E. A. & Steele, C. M. (2018). Thickened liquids for dysphagia management: A current review of the measurement of liquid flow. Current Physical Medicine and Rehabilitation Reports.

Barbon, C.E.A. & Steele, C.M. (2018). Characterizing the flow of thickened barium and non-barium liquid recipes using the IDDSI Flow Test. Dysphagia, 1-7.


IDDSI Testing Methods document (liquid and food testing in this document):

Level 3 Liquidised

Level 4 Pureed

Level 5 Minced & Moist

Level 6 Soft & Bite-Sized with Soft Banana

Minced & Moist Sandwich (information on choking risks with regular bread products)


(See also my prior post on IDDSI Replacing NDD – Links to my prior IDDSI blogs, which started in 2014.

Find many helpful links & resources on )


Go to the IDDSI YouTube Channel & to the Resources page on the IDDSI website and use the drop-down menu called: “Presentations.” IDDSI is adding new-official presentations all the time, so check often! You can easily give these presentations at your facility now to show people why we need to standardize dysphagia diets for safety and consistency.

IDDSI also posts upcoming webinars on their website along the right-hand side.

Please see the March 2018 IDDSI webinar by Dr Catriona Steele, PhD, CCC-SLP, S-LP(C), REG. CASLPO, ASHA FELLOW, hosted by the National Foundation of Swallowing Disorders (NFOSD) by clicking here:


Please enjoy my webinars that I did in collaboration with & Hormel Health Labs to bring you two FREE IDDSI webinars. Click here to transfer to the Hormel Health Labs webinar link on and enter password “hhl” (I do not make any commission on sending traffic to this site). Disclosure: I received small honorariums for my time creating and presenting these webinars.

1. International Dysphagia Diet Standardisation Initiative: The Who, Why, What & How

presented by Karen Sheffler, MS, CCC-SLP, BCS-S

2. IDDSI: Teamwork From Regulatory Requirements to Successful Implementation

presented by Brenda Richardson, MA, RDN, LD, CD and Karen Sheffler, MS, CCC-SLP, BCS-S

3. Hormel Health Labs In-service Training Series.

Designed to be quick 15-20 minute presentations that are useful for training all staff and caretakers of people with dysphagia. 


    • International Dysphagia Diet Standardisation Initiative Webinar

by Peter Lam, RD, CFE & Julie Cichero, BA, BSpThy (Hons), PhD (IDDSI Co-Chairs),

brought to you by the Association of Nutrition & Foodservice Professionals & Reinhart Foodservice

    • Standardization of Dysphagia Diets: A Model of Successful International Engagement

by Dr Catriona Steele, PhD, CCC-SLP, BCS-S, S-LP(C), REG. CASLPO, ASHA FELLOW,

brought to you by the American Speech-Language-Hearing Association (ASHA) Professional Development


Check out

  • Open Access articles (under Publications tab),
  • Prior newsletters (under the E-Bites tab),
  • Print out posters for your facility (using the Resources -> “Print and Display” tab),
  • Check out the new all-in-one IDDSI poster at this link. 
  • You will love the new Consumer Handouts for pediatrics and adults, giving you information on food examples and foods to avoid. These are so helpful for your patients.
  • Now that you are ready to Implement IDDSI: See the Implementation tab under Resources (or on the homepage too) for your Implementation Guides. These walk you through step-by-step instructions from raising awareness in your facility, building your task force, analyzing your menus, and more. Master guide available, as well as clinician and food service specific guides. See also Implementation tab for Audit sheets to help your kitchens make safe and appropriate foods.
  • Learn about how Bracco’s Varibar barium products map to the IDDSI framework (under the “Print and Display” tab),
  • Download the latest IDDSI Powerpoint presentations (under Presentations tab), and more!

PER THE IDDSI WEBSITE: “documents [on the website & resource pages] have been developed by IDDSI and are for public use. You do not need to seek permission from IDDSI to share these documents and images as long as you cite the CreativeCommons BY-SA 4.0 license as follows:”

“The International Dysphagia Diet Standardisation Initiative 2016 @
Attribution is NOT PERMITTED for derivative works incorporating any alterations to the IDDSI Framework that extend beyond language translation. Supplementary Notice: Modification of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such errors have previously been associated with adverse events including choking and death.”

New Full IDDSI Framework poster, showing framework, descriptors and testing methods. An all-in-one great IDDSI Resource! Go to:


Go to the IDDSI website:


Search “IDDSI” on your App store. Once the IDDSI app is downloaded, it can be used without any wifi or data needed. This is great for teaching at your facilities and to patients/caregivers.


Use this link to print out a blank IDDSI Flow Test Data Chart. Flow test all your facility’s thickened liquid products and supplements. 

Use this link to review my’s IDDSI Flow Test Data 2017-2018. I tested many popular brands of pre-thickened liquids, gels, and powders. I tested the old corn-starch or modified food starch products, as well as the newer “clear” products made with gums (e.g., xanthan gum). I also tested an array of supplements and even a liquid medication (e.g., Lactulose). Please send me your data to add to this massive chart!


Favorite Videos from IDDSI YouTube Channel (here they are again):

Minced & Moist Bread:

Flow Test Comparison of Levels 1-3:

Here are Those Free IDDSI Webinars Again – on

Check out our two-part series with Karen Sheffler, MS, CCC-SLP, BCS-S in Webinar 1 and Karen and a renown dietitian (Brenda Richardson, MA, RDN, LD, CD) in Webinar 2.

My Free IDDSI Podcast at FoxRehab: 

Article on ASHAwire about One Hospital’s Implementation Process: 
“Swallow Your Pride” Podcast with Simply Thick Owner – on IDDSI: 
Don’t Forget to Follow IDDSI on Twitter: 



Go to IDDSI website’s Contact Us tab, and enter your information to stay in touch for the latest news and updates.

Receive the IDDSI newsletter, the E-Bite.

Visit often. The IDDSI Framework is a “Living Document,” and will make changes as needed based on the latest evidence.

IDDSI References

IDDSI Publications:

Cichero, J.A.Y., Steele, C., Duivestein, J., et al. (2013). The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative. Current Physical Medicine and Rehabilitation Reports, 1(4), 280-291.

Steele, C.M., Alsanei, W.A., Ayanikalath, S., et al. (2015). The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology and Function: A Systematic Review. Dysphagia, 30(1), 2-26.

Cichero, J.A.Y., Lam, P., Steele, C.M., et al. (2017).  Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia, 32(2), 293-314.

Lam, P., Stanschus, S., Zaman, R. & Cichero, J.A.Y. (2017). The International Dysphagia Diet StandardisationInitiative (IDDSI) framework: The KempenPilot. BJNN/Stroke Association Supplement,13(2), S18-S26.

Steele, C.M., Namasivayam-MacDonald, A.M., Guida, B.T., Cichero, J.A.Y., Duivestein, J., Hanson, B., Lam, P. & Riquelme, L.F. (2018). Creation and Initial Validation of the International Dysphagia Diet StandardisationInitiative Functional Diet Scale, Archives of Physical Medicine and Rehabilitation, doi: 10.1016/j.apmr.2018.01.012

Another great IDDSI Resource

See this Open Access article for more information on this IDDSI-FDS – diet scale. Clinicians can more readily capture diet and liquid restrictions, as well as improvements during therapy. This scale shows greater sensitivity to diet changes than the older scale of the FOIS.

Barbon, C E. A. & Steele, C. M. (2018). Thickened liquids for dysphagia management: A current review of the measurement of liquid flow. Current Physical Medicine and Rehabilitation Reports.

Barbon, C.E.A. & Steele, C.M. (2018). Characterizing the flow of thickened barium and non-barium liquid recipes using the IDDSI Flow Test. Dysphagia, 1-7.

References noted on IDDSI Flow Test slide:

van Vliet, T. (2002). On the relation between texture perception and fundamental mechanical parameters for liquids and time dependent solids. Food Quality and Preference, 13(4), 227-236.

Kutter, A., Singh, J.P., Rauh, C. & Delgado, A. (2011). Improvement of the prediction of mouthfeel attributes of liquid foods by a PosthumusFunnel. Journal of Texture Studies, 41, 217-227.

References noted on Transitional Foods:

Gisel, E.G. (1991). Effect of Food Texture on the Development of Chewing of Children Between Six Months and Two Years of Age. Developmental Medicine & Child Neurology, 33, 69-79. doi:10.1111/j.1469-8749.1991.tb14786.x

Dovey, T.M., Aldridge, V.K. & Martin, C.I. (2013). Measuring oral sensitivity in clinical practice: A quick and reliable behaviouralmethod. Dysphagia,28(4), 501-510.


By Karen Sheffler

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