IDDSI Level 6 Soft & Bite-Sized (Blue)

Nutrition Therapy

A level 6 soft & bite-sized diet is prescribed to patients who are unable to safely bite off pieces of food but you are able to chew the food into pieces that can be swallowed.

Your registered dietitian nutritionist (RDN) can help you figure out how to include your favorite foods while following this diet.

How to Test Your Food

Foods that you can easily break apart with the side of a fork or spoon are considered safe to eat on the Level 6 Soft & Bite-Sized diet. To make sure the food is soft enough to eat, use the IDDSI fork pressure test. The IDDSI fork pressure test: Using your thumb, press down on the food item with a fork until the coloring of your nail turns white. The food passes the test when it is completely squashed and does not go back to its original shape. Make sure your food is the right size. Food particles should be no longer that 1.5 cm x 1.5 cm. For your reference: The width of a standard dinner fork or your thumbnail is about 1.5 cm. All foods you eat must meet food test requirements. Cooking method and serving temperature might affect texture. Ask you clinician for additional resources.

Tips

Cut all your food into pieces smaller than 1.5 cm x 1.5 cm.

Foods should be soft, tender, and moist so they are easier to chew and swallow.

Foods that have “mixed-consistency” can separate into solids and thin liquids or multiple textures. Mixed-consistency foods may be OK to eat if prepared in a safe way. Drain the liquid from these foods before serving or blend together to make one consistency. Examples

Cereal with milk drained

Canned fruit served with juice or syrup drained.

Soups, stews, and some casseroles, served with thick enough broth, gravy, or sauce based on testing methods.

Moist foods are easier to swallow. To keep foods moist, add small amounts of gravy, sauce, vegetable juice or cooking water, fruit juice, milk or half-and-half. Avoid large chunks of food or hard foods that need to be chewed thoroughly.

Avoid very sticky, chewy or crunchy foods. See Food Not Recommended list for examples.

Monitor foods while reheating to make sure they don’t form a tough outer crust.

 

Foods Recommended and Not Recommended

 

Food lists are based on the International Dysphagia Diet Standardization Initiative (IDDSI) Framework. Use IDDSI testing methods to confirm your foods and drinks are safe.

The following table is not a complete list of foods recommended. Other foods may be OK to eat as long as they meet IDDSI testing requirements.

Grains – Food Recommended

All well-moistened, soft cooked hot cereals with lumps no larger than 1.5 cm x 1.5 cm pieces, drained and served without excess liquid.

Cold cereal (if approved by your clinician) with lumps no larger than 1.5 cm x 1.5 cm, softened, drained and served without excess liquid.

Pregelled, soaked breads that are consistently moist throughout with no sections that have hardened.

Starches including pasta, potato, and rice dishes with pieces no larger than 1.5 cm x1.5 cm. Not sticky.

Couscous, quinoa, or rice held together with smooth, thick sauce that keeps rice from separating into individual grains.

Soft, cooked pasta dishes with pieces no larger than 1.5 cm x1.5 cm; sauce does not separate from pasta.

 

Grains – Food Not Recommended

Dry bread, toast, crackers, biscuits, muffins, pancakes, waffles, bread dressing.

Grainy, sticky, or glutinous rice

 

Protein Foods – Food Recommended

A note about red meat, pork, lamb, chicken, and casseroles: if food cannot be served soft at 1.5 cm x 1.5 cm, instead mince the food and serve moist by following Level 5, Minced & Moist guidelines.

Cooked, moist, soft and tender read meat, including beef, pork, or lam, chopped no larger than 1.5 cm x 1.5 cm pieces.

Cooked, moist, soft and tender poultry, including skinless chicken or turkey, chopped no larger than 1.5 cm pieces x 1.5 cm.

Cooked, moist, soft, tender seafood, including fish (salmon, herring, and sardines), shrimp, lobster, clams, and scallops; these foods should be soft enough to break and serve in pieces no larger than 1.5 cm x 1.5 cm pieces.

Eggs and egg substitutes, no larger than 1.5 cm x 1.5 cm pieces.

Casseroles with soft chunks of meat, ground meats or tender meats no larger than 1.5 cm x 1.5 cm pieces served in mildly, moderately, or extremely thick sauce with excess liquid drained.

Moistened soy foods, such as tofu or tempeh; soft enough to break and serve in pieces no larger than 1.5 cm x 1.5 cm pieces.

Moistened meat alternatives, such as veggie burgers, and sausages based on plant protein; chopped no larger than 1.5 cm x 1.5 cm pieces.

Sausage without skin cut into pieces no larger than 1.5 cm x 1.5 cm or ground.

Moistened legumes with soft skins/shells, such as dried beans, lentils, or peas no larger than 1.5 cm x 1.5 cm pieces and without tough skins. If incorporated into a recipe, must pass IDDSI testing methods.

 

Protein Foods – Food Not Recommended

Protein foods in sizes larger than 1.5 cm x 1.5 cm pieces.

Chicken, turkey and fish with skin on or with bones.

Sausage skin

Protein foods served with un-drained thin liquids, such as beef stew, chowders, and casseroles.

Fish with skin on or with bones; fish that you cannot break into small pieces (1.5 cm x 1.5 cm)

Fried eggs

Whole nuts and seeds (including peanuts and almonds), pistachios, and sun flower seeds.

Nut and seed butters, unless they are smooth and used in a recipe that meets testing guidelines.

Dried beans, lentils or peas that have hard shells or skins; or do not meet size expectations or do not pass IDDSI testing methods.

 

Dairy and Dairy Alternatives – Food Recommended

Yogurt (without nuts or coconut), cottage cheese with lumps no larger than 1.5 cm x 1.5 cm, and soft cheese that aren’t sticky or chewy

Cream cheese, sour cream, pudding, custard and whipped topping

Frozen desserts such as ice cream, sherbet, malts, and frozen yogurt if recommended by your clinician.

Milk, fortified soy milk, fortified nut milk in the liquid consistency recommended by your clinician.

 

Dairy and Dairy Alternatives – Food Not Recommended

Yogurt with nuts or coconut.

Hard, dry cheese, cheeses in pieces bigger than 1.5 cm x 1.5 cm pieces, and cheese that is sticky or chewy

Frozen desserts such as ice cream, sherbet, malts, and frozen yogurt, unless approved by a clinician.

 

Vegetables – Food Recommended

Soft cooked vegetables and starchy vegetables that are served steamed or boiled in pieces no larger than 1.5 cm x 1.5 cm

Peas, creamed peas and creamed corn with soft skins and free of husks; may be blended or incorporated into IDDSI safe stews and soups. If incorporated into a recipe, must pass IDDSI testing methods.

Vegetable juices must meet the IDDSI liquid consistency recommended by your clinician.

 

Vegetables – Food Not Recommended

All raw vegetables

Stir-fried or fried vegetables.

Undercooked vegetables

Peas with tough skins or shells.

Corn with husks

Cooked vegetables that are fibrous, tough, firm, or stringy such as green beans, peapods, and rhubarb

Sticky or crunchy potatoes such as mashed potatoes and potato casseroles with hard tops

 

Fruit – Food Recommended

Canned and cooked fruits, drained of excess juices, served cut up into pieces no larger than 1.5 cm x 1.5 cm or served minced or mashed.

Soft, peeled fresh fruits such as peaches, nectarines, kiwi, cantaloupe, and soft berries with small seeds (for example strawberries), cut up into pieces no larger than 1.5 cm x 1.5 cm or served minced or mashed

100% fruit juice in the liquid consistency recommended by your clinician.

 

Fruit – Food Not Recommended

Fresh fruits that are difficult to chew, have peels/skins/pits/seeds that are difficult to chew, or are hard and crunchy such as apples, grapes, or pears.

Stringy, high-pulp fruits, fibrous fruits such as papaya, pineapple, rhubarb or mango

Fruits with high water content or juice separates from solid in the mouth such as melons (unless approved by clinician)

Round or long fruits such as grapes

Uncooked dried fruits such as prunes, raisins or apricots

Fruit leather, fruit roll-ups, fruit snacks, dried fruits

 

Beverages – Food Recommended

Coffee, tea, water, 100% fruit juice, and nutritional supplements in the liquid consistency recommended by your clinician.

Beverages – Food Not Recommended

Liquids consistencies other than the liquid consistency recommended by your clinician

Other – Food Recommended

Prepared foods, including casseroles, salads, baked goods, and snacks made from recommended ingredients and served in 1.5 cm x 1.5 cm pieces

Pureed strained soups or soups with small soft pieces (1.5 cm x 1.5 cm) that meet testing guidelines

All seasoning and sweeteners, including honey

 

Other – Food Not Recommended

Soups, stews, casseroles, and prepared foods that have pieces bigger than 1.5 cm x 1.5 cm and that contain liquids that separate from the solid foods

Jelly

 

Level 6 Soft & Bite Sized (Blue) Sample 1-Day Menu

Meal      

Breakfast

1 cup oatmeal, moist, excess liquid drained, with lumps no larger than 1.5 cm x 1.5 cm

1 scrambled egg cut into 1.5 cm x 1.5 cm pieces

1 slice pregelled, soaked bread

2 teaspoons butter

½ cup mandarin oranges, drained with pieces no larger than 1.5 cm x 1.5 cm 

1 cup 1% milk (in the liquid consistency recommended by your clinician)

Lunch      

1 cup moist beef stew, excess liquid drained, prepared with pieces no larger than 1.5 cm x 1.5 cm, and served in mildly, moderately or extremely thick sauce.

½ cup cottage cheese, excess liquid drained with pieces no larger than 1.5 cm x 1.5 cm

1 slice pregelled, soaked bread

½ cup fruit cocktail, canned, drained, with pieces no larger than 1.5 cm x 1.5 cm

½ cup cinnamon custard

1 cup 1% milk (in the liquid consistency recommended by your clinician)

Evening meal

3 ounces chicken, moist, tender with pieces no larger than 1.5 cm x 1.5 cm

2  tablespoons of gravy

½ cup soft cooked potatoes, soft, cut into pieces no larger than 1.5 cm x 1.5 cm

½ cup cooked carrots, soft, cut into pieces no larger than 1.5 cm x 1.5 cm

1 slice pregelled bread, soaked bread

1 tablespoon margarine, soft

½ cup canned peaches, drained, cut into pieces no larger than 1.5 cm x 1.5 cm

1 cup 1% milk (in the liquid consistency recommended by your clinician)

Snacks

½ cup vanilla yogurt

 

 

 

 

 

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