Understanding IDDSI Levels: A Clear Breakdown for Pediatric Feeding Therapists
Published on
October 9, 2025
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Understanding IDDSI Levels
A clear breakdown of feeding textures every pediatric therapist should know — and why we no longer say “nectar thick.”
Why IDDSI Matters
The International Dysphagia Diet Standardisation Initiative (IDDSI) was created to eliminate confusion around texture-modified foods and thickened liquids. Gone are the days of vague terms like “nectar thick” or “honey thick.” Now, we use a consistent, evidence-based 0–7 numeric scale that standardizes how we describe food and fluid textures for safer swallowing.
The IDDSI Framework at a Glance
Level
Label
Example
0
Thin
Water
1
Slightly Thick
PediaSure, AR infant formula
2
Mildly Thick
Milkshake
3
Moderately Thick
Smoothie
4
Extremely Thick / Puree
Applesauce
5
Minced & Moist
Mashed Potatoes
6
Soft & Bite-Sized
Steamed veggies
7
Regular / Easy to Chew
Tender meats, soft pasta
From Thin to Puree: Liquids (0–3)
0 – Thin: Flows like water. No modification needed. Safe for most children.
1 – Slightly Thick: Think PediaSure. Slightly more resistance when drinking. Often used with AR formulas.
2 – Mildly Thick: Milkshake-like. Pours from a spoon. For children with reduced tongue control.
3 – Moderately Thick: Smooth smoothie. No bits. Requires more oral propulsion. Cannot be eaten with a fork.
5 – Minced & Moist: Mashed potatoes with soft lumps. Minimal chewing. Great for missing teeth or oral fatigue.
6 – Soft & Bite-Sized: Steam-soft veggies, small-cut meat. Must be chewable. No knives needed.
7 – Regular: Easy-to-chew soft solids. No seeds, tough skins, or crunchy textures.
🧪 Savorease: Between Levels 6 and 7
Developed by a dentist, Savorease is a dissolvable, all-natural snack that melts in the mouth — ideal for children who are in-between solid readiness. It’s especially helpful for kids with oral aversion, post-trauma, or dental limitations.
🩺 Always observe oral-facial fatigue, tongue propulsion, and gulping sounds during trials.
👂 Auscultation (before, during, and after swallow) can catch subtle signs of aspiration.
🥤 Trial using different vessels — bottles, sippy cups, straws, forks, and spoons — for cross-functional observations.
👪 Teach parents how to reference IDDSI levels instead of using outdated texture terms.
How to Explain IDDSI to Parents
Instead of saying “soft solids” or “thickened drinks,” walk them through levels:
“Your child is currently eating at a Level 4, which means puree-only textures like applesauce. Once they safely manage tongue propulsion and oral control, we may trial a Level 5 minced option like mashed potatoes.”
Ready to implement IDDSI levels in your therapy?
Sanctum Health Partners provides hands-on training, feeding supplies, and support to help your kids succeed at every level.
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