IDDSI has received many questions from clinicians regarding the use of the IDDSI framework when working with people who may need softer choices of a regular diet with no particle size restriction for reasons other than dysphagia where there is a risk for aspiration or choking.
Currently this food choice would fall under IDDSI Level 7/Regular with no particle size restriction as opposed to Level 6/Soft and Bite sized, which specifies particle size restriction. IDDSI Level 7/Regular includes normal, everyday foods of various textures that are developmentally and age appropriate. This may include hard and crunchy foods as well as those which are naturally soft. Softer choices of a regular diet with no particle size restriction are often required in residential or age-care facilities or in community.
The IDDSI Board of Directors has had extensive discussions regarding this issue and a survey will be circulated in the near future to our IDDSI global community seeking a label for soft foods without particle size restriction. Through these discussions, the IDDSI Board has determined the following guiding principles to consider when responding to our survey.
- The IDDSI Framework is intended to be used for people with dysphagia, where there is a risk of aspiration or choking.
- The IDDSI Framework is NOT intended for people without dysphagia or recognized choking risk.
- The IDDSI framework mirrors previous/existing national dysphagia diets that define a particle size for ‘soft’ food to reduce choking risk.
- The determination as to whether a person has choking risk and requires “Level 6 Soft and Bite-Sized food” requires clinical assessment, decision-making and documentation.
- There are some situations where people who do not have dysphagia or an increased choking risk might still benefit from ‘soft’ food. When there is no increased risk of choking, the particle size specification is not needed. Just as it is possible to order a therapeutic diet that involves specifications like “diabetic” or “renal”, we appreciate it is important to be able to order regular foods (without a particle size restriction) that are soft...
We encourage everyone to watch for and respond to this survey!!