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IDDSI framework levels 0 to 7

Pick a level for its descriptor, examples and testing method, or search the food table below.

The short answer

A food does not have an IDDSI level. Its preparation does. That is why "what level is a banana" has four answers: a banana is Level 7 whole, around Level 6 ripe and sliced, around Level 5 mashed, and Level 4 only once it is pureed smooth.

Whole, raw
Level 7 Regular / Easy to Chew
Ripe, sliced into bite-sized pieces
Level 6 Soft & Bite-Sized
Mashed, some lumps
Level 5 Minced & Moist
Pureed smooth
Level 4 Extremely Thick / Pureed

Levels 0 to 4 cover drinks and Levels 3 to 7 cover foods, so 3 and 4 span both. Confirm the level by testing the item in front of you: appearance is unreliable, which is exactly why IDDSI publishes the flow, fork drip, spoon tilt and fork pressure tests. Educational reference only.

Educational reference only, not clinical advice.

This tool summarises the framework for reference. Follow the current IDDSI descriptors and testing methods and your local dysphagia policy when modifying a diet or thickening a fluid.

© The International Dysphagia Diet Standardisation Initiative 2019. iddsi.org/framework. Licensed under the CreativeCommons Attribution-Sharealike 4.0 International Licence (CC BY-SA 4.0). IDDSI level descriptions, testing methods and level colours reproduced or adapted on this page are available under the same terms. See our Attributions and Data Sources.

Choose a level (0 to 7)

Levels 3 and 4 span both drinks and foods. Colours follow the official IDDSI colour for each level.

Drinks

Thin

Level 0

Flows like water. A person who is prescribed thin fluids can manage all drink consistencies, so no thickening is added.

IDDSI colour: White Drinks

Everyday examples

  • Water
  • Tea and coffee
  • Juice
  • Soft drink
  • Milk

IDDSI testing method

IDDSI Flow Test: the drink flows through a 10 mL slip-tip syringe just like water. Less than 1 mL is left in the syringe after 10 seconds.

Food examples

What level is it? It depends how it is prepared.

A food does not have an IDDSI level — its preparation does. A banana is Level 7 whole, Level 6 sliced when ripe, Level 5 mashed and Level 4 only when pureed smooth. These are illustrations of the descriptors, not a lookup: confirm the level by testing the item in front of you, because appearance is unreliable and that is exactly why IDDSI publishes the flow, fork drip, spoon tilt and fork pressure tests.

Banana

  • 7 Whole, raw — Regular / Easy to Chew
  • 6 Ripe, sliced into bite-sized pieces — Soft & Bite-Sized Only if soft enough to squash with a fork.
  • 5 Mashed, some lumps — Minced & Moist
  • 4 Pureed smooth — Extremely Thick / Pureed

Weet-Bix

  • 7 Dry — Regular / Easy to Chew Dry and crumbly. Often unsuitable below Level 7.
  • 5 Soaked soft in milk, no free liquid — Minced & Moist
  • 4 Soaked and blended smooth — Extremely Thick / Pureed

Caution: Cereal in milk is a mixed consistency -- solid pieces in thin fluid -- which is higher risk than either part alone.

Bread

  • 7 Normal bread or toast — Regular / Easy to Chew
  • 6 Crusts removed, cut small — Soft & Bite-Sized Still unsuitable for many. Bread forms a bolus that is hard to clear.

Caution: Bread is a common choking hazard in dysphagia and is excluded from many texture-modified diets entirely, including at Level 6.

Potato

  • 7 Roast or chips — Regular / Easy to Chew
  • 6 Boiled, cut to bite-sized — Soft & Bite-Sized
  • 5 Mashed with a little liquid, no lumps — Minced & Moist
  • 4 Pureed smooth with no free liquid — Extremely Thick / Pureed

Meat

  • 7 Whole cut — Regular / Easy to Chew
  • 6 Tender, cut to 1.5 cm pieces — Soft & Bite-Sized Bite-sized is 1.5 cm for adults, 8 mm for paediatrics.
  • 5 Finely minced with smooth gravy — Minced & Moist Lumps no bigger than 4 mm (adult).
  • 4 Pureed smooth — Extremely Thick / Pureed

Caution: Stringy or tough meat is a common cause of choking and is unsuitable above the level its texture actually meets.

Fish

  • 7 Fillet, bones removed — Regular / Easy to Chew
  • 6 Soft, flaked with a fork — Soft & Bite-Sized
  • 5 Flaked and moistened with sauce — Minced & Moist
  • 4 Pureed smooth — Extremely Thick / Pureed

Caution: Bones. Check every preparation, including flaked and pureed.

Rice

  • 7 Steamed, loose grains — Regular / Easy to Chew Loose grains scatter and are hard to control -- frequently excluded below Level 7.
  • 5 Sticky or congee-style, moist and cohesive — Minced & Moist
  • 4 Blended smooth — Extremely Thick / Pureed

Pasta

  • 7 Normal — Regular / Easy to Chew
  • 6 Well cooked, cut small, with sauce — Soft & Bite-Sized
  • 5 Finely chopped with smooth sauce — Minced & Moist

Caution: Long shapes such as spaghetti are difficult to control. Short cut shapes are safer at the same level.

Scrambled egg

  • 7 Boiled or fried — Regular / Easy to Chew
  • 6 Soft scrambled, moist — Soft & Bite-Sized
  • 5 Soft scrambled, finely chopped and moist — Minced & Moist
  • 4 Pureed smooth — Extremely Thick / Pureed

Caution: Dry or rubbery scrambled egg does not meet Level 6 regardless of how it is described on a menu.

Custard

  • 3 Thin, smooth, pours readily — Moderately Thick / Liquidised Level 3 spans drinks and foods.
  • 4 Thick and smooth, holds shape on a spoon — Extremely Thick / Pureed

Soup

  • 0 Clear broth — Thin Thin fluid. Thicken to the prescribed drink level if required.
  • 3 Smooth pureed soup, no lumps — Moderately Thick / Liquidised
  • 4 Thickened to hold its shape on a spoon — Extremely Thick / Pureed

Caution: Soup with solid pieces in thin liquid is a mixed consistency and is higher risk than either component alone.

Jelly

  • 7 Standard jelly or ice cream — Regular / Easy to Chew Both melt to a THIN fluid at body temperature.

Caution: Anything that melts to thin fluid in the mouth is unsuitable for someone prescribed thickened drinks, whatever its texture on the spoon.

Apple

  • 7 Whole or sliced, raw — Regular / Easy to Chew
  • 6 Stewed until soft, bite-sized — Soft & Bite-Sized
  • 5 Stewed and mashed — Minced & Moist
  • 4 Pureed smooth — Extremely Thick / Pureed

Pumpkin

  • 6 Roasted or steamed, bite-sized — Soft & Bite-Sized
  • 5 Mashed with a little liquid — Minced & Moist
  • 4 Pureed smooth — Extremely Thick / Pureed

Caution: Peas, corn kernels and other small round items are choking hazards and are excluded from most modified diets even when soft.

Cheese

  • 7 Block or slices — Regular / Easy to Chew
  • 6 Soft, cut to bite-sized — Soft & Bite-Sized
  • 4 Grated into a smooth sauce — Extremely Thick / Pureed

Caution: Firm cheese is cohesive and sticky and is a recognised choking risk.

Nuts, popcorn and seeds

  • 7 Any form — Regular / Easy to Chew Hard, dry, crumbly or small-and-round. No safe texture-modified preparation.

Caution: These are among the highest-risk foods for choking and are excluded from every texture-modified level. Whole grapes and cherry tomatoes carry the same concern.

Texture decisions are made by the treating team with the speech pathologist, against the patient's assessment and your local dysphagia policy. This table is educational only.

After the level

Look the level up in the record you are already writing.

A texture decision that lives in a browser tab has to be retyped into the note, and the retyping is where it goes wrong. AI Dietitians is Australian clinical dietetics software for APDs, with the IDDSI framework reference sitting next to the calculators, the food composition data and the patient record.

  • IDDSI framework reference, on every plan
  • Enteral and ONS product catalogue and the Australian Food Composition Database
  • Patient education handouts with illustrations and translation, on Pro
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FAQ

IDDSI framework questions.

What level on the IDDSI framework would a banana be?

It depends entirely on how the banana is prepared, because a food does not have an IDDSI level, its preparation does. A whole raw banana is Level 7 (Regular). Ripe and sliced into bite-sized pieces it is around Level 6 (Soft and Bite-Sized), but only if it is soft enough to squash with a fork. Mashed with visible lumps it is around Level 5 (Minced and Moist). Pureed smooth it is Level 4 (Pureed). Confirm the level by testing the item in front of you with the IDDSI fork pressure, fork drip or spoon tilt test, because appearance is unreliable and texture decisions sit with the treating team and the speech pathologist.

What is IDDSI?

IDDSI is the International Dysphagia Diet Standardisation Initiative. It describes a single, continuous framework of eight levels, numbered 0 to 7, that gives standard names, descriptors and testing methods for texture-modified foods and thickened drinks. It is used internationally to reduce confusion between services when a person has swallowing difficulties (dysphagia). Always follow the current IDDSI descriptors at iddsi.org and your local policy.

What is IDDSI Level 4?

Level 4 is Extremely Thick as a drink and Pureed as a food. It is usually eaten with a spoon rather than drunk from a cup or sipped through a straw. It is smooth with no lumps, holds its shape on a spoon and is not sticky, and the liquid must not separate from the solid. It is confirmed with the Fork Drip Test and the Spoon Tilt Test. Confirm against the current IDDSI descriptors.

What is IDDSI Level 5?

Level 5 is Minced and Moist. The food is soft and moist with small, soft lumps that are easy to squash with the tongue, served with a smooth thick sauce or gravy so it stays cohesive. Lumps are no bigger than 4 mm for adults or 2 mm for paediatric patients, checked with the Fork Pressure Test. Confirm against the current IDDSI descriptors.

What is IDDSI Level 7?

Level 7 has two forms. Regular covers everyday foods of all textures with no restriction. Easy to Chew (Level 7 EC) covers soft and tender everyday foods that still need chewing but not the size or texture limits of the lower levels. Both require the ability to chew safely, and neither restricts thin fluids unless that is separately prescribed. Confirm against the current IDDSI descriptors.

How do I test a thickened fluid?

Drinks at Levels 0 to 3 are checked with the IDDSI Flow Test. You draw 10 mL into a 10 mL slip-tip syringe, release the plunger for 10 seconds, then read how much liquid is left: less than 1 mL is Thin (0), 1 to 4 mL is Slightly Thick (1), 4 to 8 mL is Mildly Thick (2) and 8 to 10 mL is Moderately Thick (3). Thicker samples use the Fork Drip Test and Spoon Tilt Test instead. Always follow the current IDDSI method.

Where did IDDSI come from?

IDDSI was founded in 2013 by a group of volunteers from several countries and professions, including dietetics, speech pathology, nursing, medicine, food science and engineering. The framework was published in 2016 to standardise texture-modified diet and thickened-fluid terminology worldwide. The framework is the work of the IDDSI and is published under a CreativeCommons Attribution-Sharealike 4.0 licence, so it can be used and adapted provided IDDSI is attributed and adaptations are shared on the same terms. The current descriptors are at iddsi.org.

Every answer is an educational summary only. Follow the current IDDSI descriptors and testing methods at iddsi.org and your local dysphagia policy.