IDDSI Resources

By: Karen Sheffler

November 29, 2017


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

Click Here for picture of framework

IDDSI Resources

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

Global standardisation is here. The world reached consensus on how to label, describe and test dysphagia diets for people with difficulty swallowing (dysphagia). All solid food levels and drink/liquid levels have been given standard names, descriptions, colors, numbers, and testing methods. We can all finally speak the same language when it comes to ordering dysphagia diets through preparing and serving these dysphagia diets. Changing the world to this new dysphagia diet global standard has been an ongoing implementation process. For healthcare facilities/institutions that have not yet implemented IDDSI, it is crucial that they set goals for their facilities now. This is now the only professionally recognized standard of care. 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 for a given institution will be expected to take more than a year (or even two) 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. See also this newer blog: IDDSI Updates.

Start now with plugging into the IDDSI website to start your own learning, then begin raising awareness in your facility and forming a team. Find your champions in your facility. For example, in our hospital the chef was already familiar with creating foods for people with dysphagia, as she had been cooking for the ALS luncheons for years. You can already start dual-labeling in your reports (i.e., use your facility’s old diet terms after the new IDDSI names). For more on best practice terminology: check out the PowerPoint in the USIRG chart called: USIRG Best Practice IDDSI Terminology (Powerpoint).

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.

Here are those resources:


IDDSI Framework Evidence Statement:

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

IDDSI Webinar on the IDDSI YouTube Channel: Sep. 18, 2018 Using the IDDSI Flow Test in Clinical Practice


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 with Links to my prior IDDSI blogs, which started in 2014.

Also, please see the list blogs related to IDDSI below.


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 E-Bites newsletters (under the News tab),
  • Print out posters for your facility (using the Resources -> Posters tab),
  • You will love the Patient/Caregiver Handouts tab 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 for your clinician or industry specific 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 Audit Tools to help your kitchens make safe and appropriate foods, and to assist staff with point of service testing.
  • Learn about how Bracco’s Varibar barium products map to the IDDSI framework,
  • Check out Introduction to IDDSI Powerpoint presentations (under Videos tab), and follow their link to their YouTube Channel for many presentations and videos.

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.”

Full IDDSI Framework poster, showing framework, descriptors and testing methods. Go to: ADULT VERSION & PEDIATRIC VERSION



Go to the IDDSI website:

Go to the USIRG chart in section #6 for our Frequently Asked Questions that are USA specific.


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!

See IDDSI’s 2023 resource on their new IDDSI Funnel:



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

Minced & Moist Bread:

Flow Test Comparison of Levels 1-3:

Here are many of my IDDSI-related blogs: 

  1. Dysphagia Diets: IDDSI Replaces NDD
  2. Diet Safety: Terminology & Definitions Matter
  3. “No Dysphagia Diet Modification without Standardization!”
  4. IDDSI: Interview with an Early Adopter of IDDSI Framework
  5. Snacks for People with Dysphagia (IDDSI Style)
  6. Cotton Candy Therapy? Transitional Foods & Dysphagia Treatment
  7. Patient Safety First: Transitional Foods (Part 2)
  8. Jelly & Jell-O Surprise: What’s Up With Jell-O, Jelly Cups, Dysphagia Training Jelly
  9. Diet Modification Without Mastication Evaluation?
  10. Dysphagia Puree Replaced by “Pureed” & “Liquidized”
  11. Why Puree?
  12. Dysphagia Ground Replaced by Minced & Moist
  13. Dysphagia Advanced Replaced by Soft & Bite-Sized

Here are Those Free IDDSI Webinars Again – on

Note: As of 2021, these are slightly out-of-date now with old framework that did not have the “Easy to Chew” level.

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 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.