How do I know I have the right texture for Level 5 minced and moist?
Level 5 Minced and Moist foods are intended to mimic a “chewed bolus” for individuals who have minimal chewing ability but still have the ability to move tongue to transport the food and apply pressure to the small soft particles.
The goal of this texture is to ensure the bolus can be swallowed safely if not chewed, but to also allow opportunity to use any minimal chewing and tongue manipulation skills that the individual has.
For Level 5 Minced and Moist the 3 key considerations are:
All of these must be considered and tested using the recommended IDDSI tests to ensure the food meets all the criteria for Level 5 Minced and Moist.
a) Particle size:
Research into food particles size of chewed boluses in healthy adults suggests averages of 2-4 mm depending on the type of food being chewed. However food particles in a chewed bolus are not necessarily all uniform in size and particles need to be considered in dimensions of width, depth and length.
Level 5 minced and moist particle size for an adult has been outlined as a 4mm ‘lump size’ to account for the fact that a chewed bolus is unlikely to be neat in all dimensions. Items such as rice are considered suitable for a Level 5 Minced and Moist diet. By this inclusion it offers people with swallowing difficulties something that still looks like food they recognise, thereby enhancing compliance and intake. Most rice grains are at least 8-10mm in their long dimension, but meet the 4mm width dimension. Risoni and orzo pasta are also examples that are similar to rice and meet the Level 5 requirements of ‘minimal chewing needed’.
The rationale to having it ‘not necessarily even in all dimensions’ is that it has clinical utility in encouraging some minimal chewing. This is beneficial from a clinical perspective to allow progression to Level 6. It is not intended that the particles
to be 4x4x15mm, but that they should be 4mm lump and ‘no more than 15mm’ in the length dimension. Hence rice is acceptable because its 4mmx2mmx10mm for example) – it’s a subtle but important difference.4x4x4mm would also be an acceptable variant – because it is 4x4mm and ‘less than 15mm’ in the other dimension. 4 mm is the space between the tines of an ordinary dinner fork. In consideration of the smaller anatomy of young children, the recommendation is for no larger than 2mm x2mm x no larger than 8mm* is recommended for pediatric populations. (2 mm is half the distance of the space between the tines of a regular dinner fork.)
*15 mm for adults and 8 mm for children are considered small enough to not obstruct the airway.
Clinical assessment should always be used to determine if an individual has the ability to safely manage the particle size outlined in Level 5 minced and moist.
b) Food properties:
Research regarding particle size of chewed boluses has also found that hard foods such as nuts and raw carrots will be chewed to smaller size particles(~2mm) before swallowing, than softer foods.
Level 5 minced and moist, specifies that foods must be soft enough to squash easily with minimal pressure from a fork or spoon.
c) Moisture content:
Research also suggests that in healthy adults, foods will be chewed into small particles and mixed with saliva until there is sufficient moisture to lubricate the bolus for swallowing.
Level 5 minced and moist specifies that foods must have adequate moisture to hold the bolus together without being sticky or too runny. The spoon tilt test should be used to ensure food is not too dry or sticky and the fork drip test should be used to ensure the food is not too runny.
It is essential that Level 5 minced and moist foods meet ALL the criteria to best “mimic” a chewed bolus just prior to swallowing.