March 2026 IDDSI e-bite

This e-bite, we bring some sobering thoughts about food texture and safety which takes us back to why the IDDSI framework was developed for the global community…. 

Choking Alert – Bread 

The IDDSI Framework specifically notes bread, toast and sandwiches as food textures that pose a choking risk.

Bread is a general term that can cover anything from… white processed bread, to high fibre brown or multigrain bread, dense rye bread, sourdough, brioche, pumpernickel, and flatbreads like pita, naan and others. Unsurprisingly, different types of bread have different textures. Some breads are light and airy, some are dense, hard, and chewy, some have a crispy crust with a chewy interior, some have air pockets, some are very dry, some are very fibrous, some have a large crumb and some have a small crumb. “Bread” is a GENERAL TERM that is open to personal interpretation. “Bread” is a complex textured food. 

In healthy people bread is broken into many small particles throughout the chewing process. Apart from chewing, the addition of saliva is important for helping to break breadtexture down. Google tells us the average weight of a slice of bread is 25-40g (0.9-1.4oz). In research studies pieces of bread that were only 5g pieces were given to healthy people who were asked to chew it until ready to swallow. The average healthy person, with all their own teeth, chewed the small piece of bread 28-34 times until they felt it was ready to swallow. How many of our patients have the strength, stamina and dentition to chew each mouthful of bread 28-30 times before swallowing? Do we count? Do we check to see that the pieces of bread are small and moist? 

In February 2026, IDDSI was alerted to the findings of a Coronial investigation into the deaths of two people who resided in an aged care facility in Australia. The inquest came about because questions arose regarding whether they were provided with food and fed in accordance with their dietary restrictions. Both were on IDDSI Level 5 Minced & Moist Diets where no regular dry bread, sandwiches or toast of any kind is allowed. Yet both had choked and died while eating bread. This is an important clinical practice alert – bread is a choking risk. 

For one of the residents, there had been a practice of dipping bread into tea or other drinks. This practice is common, however different types of bread soak up moisture differently. There is no way to know how much moisture has been added to a piece of bread using this process. The Coroner asked whether dipping bread into liquid was ‘gelled bread’? The Coroner found that the term ‘gelled’ was not defined and is therefore open to interpretation. The inquest demonstrated a general misunderstanding by staff about what actually constitutes gelled bread and how it is appropriately prepared. The Coroner further queried whether gelled bread ought to be removed as a permissible food as part of a minced and moist diet.

The eyewitness reports of food choking are harrowing. For family members it is extremely traumatic. The Coroner noted that ‘inquests and the coronial process are as much about life as they are about death. A coronial system exists because we, as a community, recognise the fragility of human life and value enormously the preciousness of it.

Coming up for 10 years since publication of the original IDDSI Framework Detailed Definitions, IDDSI is in the process of reviewing the IDDSI Detailed Definitions Document, considering and acting upon Coronial findings and new evidence. 

The Australian Coroner also recommended consistent minimum training expectations for kitchen and nursing staff in residential aged care facilities, specifically directed to the identification and management of choking risk among residents, including alignment with the International Dysphagia Diet Standardisation Initiative. 

Want to read more: 

• Coroner’s Court of New South Wales, 27 February 2026. Inquest into the deaths of Dimosthenis Gesios & Maureen McGreevey. Findings of Magistrate Derek Lee, Deputy State Coroner. 

• Cichero J & Lam P (2018) What’s the evidence can bread ever be compatible with a texture modified diet? JCPSLP, 20: 165-169 

• Tournier C, Grass M, Septier C et al. (2014) The impact of mastication, salivation and food bolus formation on salt release during bread consumption. Food & Function, 5: 2969-2980.

Many thanks to Dr. Julie Cichero, Expert witness for the Crown Solicitor assisting the NSW State Coroner in various matters, IDDSI Co-Founder and Past Co-Chair, for writing this article.

Dysphagia Research Society 2026: Congratulations to the organizers at DRS on a very successful Dysphagia Research Society Annual Conference held March 4 -7, 2026 in Denver, Colorado. The conference offered both a virtual and in person option with a plan for all virtual in 2027. 

See DysphagiaResearch.org for more details and next years save the date: https://www.dysphagiaresearch.org/page/2027-Annual-Meeting

It is important for IDDSI to have a presence at conferences ongoingly to make sure this standardised framework of IDDSI remains prominent in the research methods and minds of all dysphagia researchers and clinicians around the world. 

We thank international reference group members, Drs. Carlos Manzano of Mexico and Mari Nakao-Kato of Japan for making the journey to the USA for this dysphagia collaborative conference. IDDSI would like to also share our congratulations to Mari Nakao-Kato (Japan IRG Leader) as the recipient of the 2026 NFOSD Michael Donovan Advocacy and Innovation award at DRS. Well done Mari! 

We also thank industry supporters of Lyons Health Labs, IDDSI Global Platinum Sponsor (booth with IDDSI resources like IDDSI funnels and testing cards) and Simply Thick, IDDSI Global Platinum Co-Sponsor (John Holahan for being there in person) for their ongoing support.

Greetings from the DGD (German Dysphagia Society) Conference.

Simon Sollereder, IDDSI DACH IRG Leader, presented the results from an IDDSI implementation survey on 132 Hospitals across the DACH Region.

ProjectReachOUT

Brazil: The Brazil IRG are proud to announce they have received a letter of support from the Federal Council of Speech-Language Pathology of Brazil, one of the largest professional entities in the country, which guides more than 50,000 Brazilian speech-language pathologists. They have also confirmed support from the National Academy of Palliative Care (ANCP), a new scientific institution that has formalized its support for IDDSI in Brazil. Click HERE to view the Letters of Support. Significant advancements in the field of dysphagia are occurring in Brazil and the Brazil team are continuously striving to bring IDDSI to key technical and scientific discussions.

Saudi Arabia: The Saudi Arabia IRG is pleased to announce that the Saudi Society of Speech-Language Pathology and Audiology (SSSPA) has confirmed to serve as a local IDDSI supporter of Saudi Arabia. Go to the Saudi Arabia webpage HERE to view their Letter of Support.

Congratulations to you all and thank you for all your hard work and efforts!

Global Updates

Philippines: Ma’am Neema McTomney of the Philippines IRG and Co-Leader of Asia IDDSI Conference 2028 planning team, was presenting about IDDSI at Academic Fiesta 2026 to increase awareness about IDDSI. Congratulations on an amazing event!

See all the details on the IDDSI's social media HERE

USIRG: US IRG Leaders and Global IDDSI Leaders were present at the Dysphagia Research Society's annual conference on March 4-7 in Denver Colorado. Read all about it, and more of the upcoming virtual conferences on the USIRG Webpage

If you haven't already, be sure to register for the remaining US IDDSI Virtual Conferences HERE

If you are interested in joining an IDDSI Reference Group, please email the contact for the group. We welcome everyone who wants to help with guiding & fostering IDDSI implementation. Being part of a reference group is a great opportunity to meet IDDSI friends in your local, regional area. And you never know, something amazing may happen when great brains come together!

Don't see an IDDSI Reference Group for your practise or regional area? Interested in starting an IDDSI reference group to help support IDDSI implementation in your regional or practice area? Let us know!

Current Webinars and IDDSI Learning

US IDDSI Virtual Conference 2026 is happening NOW



Everything you need to know about Implementation! Join USIRG experts for a 6-part series at a low price.

• Jan 28 (recording available)
• Feb 25 (recording available)
• Mar 4 (recording available)
• April 29
• May 20
• June 3

Approved for 0.6 ASHA CEUs and 6 CE hours CBDM/ANFP. Currently pending CRD review and approval for 6 CPEUs.

Meet our Feature Speakers for the March and April sessions.For their full bios and other speaker information go to the USIV Event

April 29, 2026:

• Rose Britt, RDN, CNSC
• Rene Kanadet, MS, CCC-SLP, BCS-S
• Mary Rybicki, MS, RDN, LDN

May 20, 2026:

• Alexa Kirtley, Chef
• Lori Reamer, RDN
• John Holahan, BS, MBA

Upcoming IDDSI Events

Festival IDDSI Latinoamérica

Date: Tuesday, May 19th, 2026, 8:00 AM – 5:30 PM

Venue: Anáhuac University, in Cancún, Mexico, Av. Universidad Anáhuac 46 Lomas Anahuac, 52786 Lomas Anáhuac, Méx., Mexico

Early Bird Registration available until March 31, 2026

This Festival will be presented in Spanish.

UK IDDSI Festival 2026 "Quality at Every Level"

Date: Tuesday, September 15th, 2026, 9:30AM–4:30PM

Venue: Reach Conference Centre, Riverside Court, Pride Park, Derby DE24 8HY

The only festival organised by the IDDSI UK Reference Group is back for ONE DAY ONLY, so don't wait to get your Early Bird tickets!

£65+VAT early bird rate before 1st May, 2026 and £80+VAT thereafter

**Registration includes lunch

For more details go to the UKIF Event and for further inquiries please contact ukevents@iddsi.net

Save the Date: Canada IDDSI Virtual Conference 2026

The virtual conference features a 6-part webinar series offering a wide range of speakers with practical IDDSI topics, tips and tricks. Everyone is welcome to join!

Dates: Sept 17 & 29; Oct 15 & 27; and Nov 12 & 24, 2026.

Venue: Online

Sessions start at 1pm EST and are 75 minutes long.

Stay tuned for registration details!

To pre-register for this event, please fill out this FORM

Use this form to express your interest in attending. You will be notified when registration opens.

Or you can also see more information and can pre-register on the IDDSI Asia Event Webpage

Where to Find Us

• IV Latin American Dysphagia Congress (CLAD IV) organized by SLAD (Latin American Dysphagia Society) Conference, Wed, May 20 to Sat, May 23, 2026, Cancún, Mexico IV Latin American Congress of Dysphagia (EN)

If you are aware of other events where IDDSI will be featured, please share the information with us by sending the details to: office@iddsi.org