Food and drink levels, explained

What IDDSI is

IDDSI is an international group. It made one set of names for food and drink textures.

Hospitals, care homes and SLPs in many countries use it. The same number means the same thing everywhere.

One scale, from 0 to 7

Drinks use levels 0 to 4. Foods use levels 3 to 7. Levels 3 and 4 can be a thick drink or a smooth food.

Drink levels

• Level 0, Thin: flows like water.
• Level 1, Slightly thick: a little thicker than water.
• Level 2, Mildly thick: pours quickly off a spoon. Still sipped from a cup.
• Level 3, Moderately thick: can be drunk from a cup or taken with a spoon.
• Level 4, Extremely thick: holds its shape on a spoon. Eaten, not drunk.

Food levels

• Level 3, Liquidised: smooth, with no lumps, and pourable.
• Level 4, Pureed: smooth, holds its shape, needs no chewing.
• Level 5, Minced and moist: small, soft, moist lumps. Very little chewing.
• Level 6, Soft and bite-sized: soft, moist pieces about the size of a thumbnail.
• Level 7, Regular: everyday foods. There is also an easy-to-chew version.

What you might notice

• Hospital menus and care homes may use these numbers and their colors.
• Ready-made thick drinks and thickeners often show a level on the label.
• Thickened drinks can taste and feel different. Some people drink less of them.
• A level can change over time, in either direction.

What can help

A level is a recommendation based on a swallow test. Knowing what it means helps you weigh it and talk it through.

• If a level is suggested, ask why, and what it is meant to do.
• Ask about trade-offs: taste, drinking enough, eating out, and how you feel about it.
• Choosing a level on guesswork is not the same as testing. Base changes on what a test showed.
• Use the exact mixing steps on the product or from the person who showed you. Guessed amounts can make a drink the wrong thickness.
• IDDSI has simple home checks, like a flow test and a fork test. Ask someone to show you.

Questions to ask your care team

• Which level are you suggesting, for food and for drinks?
• What did my test show that points to it?
• What might happen if I choose a different level?
• How do I check a drink or food at home?
• What about my pills and medicines?
• When will we look at the level again?

When to get help

Get checked soon if you notice any of these. A doctor or SLP can look at what is going on.

• Coughing or choking when you eat or drink.
• Food or pills that feel stuck.
• Losing weight without trying.
• Pneumonia or chest infections, especially if they come back.