Dear Caregivers, Do you ever have questions if you are puréeing your food correctly for your loved one on a puréed diet? The number one question I get on initial visits is what can I feed them, followed by what is puréed food supposed to look like, and lastly how do I do it?
Having to prepare foods for a person on a puréed diet can provoke lots of worries, anxieties and fears about doing it right. Understandably, carrying the burden of responsibility to provide another persons daily nutrition and hydration needs on top of the need for a specialized diet consistency for their health is enough to increase the stress levels of a caregiver exponentially.
In this post, I will explain the definition of puréed food that is used by institutions worldwide. Does your puréed food have to look the same as what the food looked like when your loved one was in the hospital or rehabilitation setting? I will answer this question of what this means for a caregiver in the home setting.
I’ve seen over the years many terms and labels used to describe the various diet consistencies a person can be put on according to their specific swallowing problem. These diet consistencies are designed to make a person with swallowing problems safer by eliminating or decreasing their risk of choking, aspirating and /or causing or exacerbating respiratory illnesses.
A modified diet may also be used for maximizing oral intake by making the consistency easier to swallow, or for conserving a person’s energy when eating or drinking, or a temporary measure for a person to recover from a severe illness, surgery, injury or delirium.
Introduction & History of IDDSI:
In 2013, a group of experts in the field of dysphagia joined forces to develop a universal standard for managing dysphagia through diet modifications. The goal was to create standardization that would clarify terminology and guidelines among healthcare providers, caregivers and patients to improve consistent care and improve safety risks for individuals with dysphagia.
This global collaboration group of professions designed a framework that was named International Dysphagia Diet Standardization Initiative. Over the next couple of years they did research and released the first framework in 2015 that introduced a continuum of levels for drinks and foods.
In 2016 adjustments were made and a final framework for IDDSI was published. The framework provided detailed descriptions and testing methods to determine the appropriate level of food and drink texture.
2017-2019 was focused on promoting the adoption of the framework worldwide. The creation of educational material, training programs and resources were made available to facilitate implementation in various healthcare settings.
The adoption and implementation of IDDSI has made a powerful impact on improving the management of dysphagia globally. It has been supported by major organizations. The initiative continues to promote education, collaboration and research to offer a consistent and evidence-based approach to diet modification.
TIP: There are other diet consistency terms still being used to describe various modified textured levels . You may see terms such as mechanically altered, dysphagia diet, mechanical soft or dysphagia advanced. I ask the dietary department personnel what terms they use and how the food is prepared for each level they provide at any particular setting.
Puréed Food Guidelines & Tests Per IDDSI:
The IDDSI official website, IDDSI.org has PDF files that can be printed with their licensing laws and regulations for use of their materials. Their website has easy to read material . It has detailed descriptions, pictures and information on how to test for each level consistency for foods and liquids.
There are guidelines for Level 0 – Level 4 for liquids and Level 4 – Level 7 for foods. The following information has come from their online material. For the purpose of this post, we are focusing on puréed foods.
Level 4 – Pureed food.
- Are usually eaten with a spoon
- Do not require chewing
- Have a smooth texture with no lumps
- Hold shape on a spoon
- Fall off a spoon in a single spoonful when tilted
- Are not sticky
- Liquid (like sauces) must not separate from solids
Puréed food must pass two different tests per IDDSI guidelines. These are depicted in the resource material. These tests include:
- IDDSI Fork Drip Test: Liquid does not dollop, or drip continuously through the fork prongs . A small amount may flow through and form a tail below the fork.
- IDDSI Spoon Tilt Test: Sample holds its shape on the spoon and falls off fairly easily if the spoon is tilted or lightly flicked. Sample should not be firm or sticky.
TIP: I share this system for classifying levels of food and liquid textures as it is increasingly becoming widely used in the U.S.. You may see these levels and terms used by your health care team or on the discharge paperwork you have from the hospital or a treating facility. Please go to their website, IDDSI.org for further detailed information of all the food texture and liquid texture guidelines and tests for each level.
TIP: Additionally, there is no mandate for a healthcare facility to follow or implement any dysphagia classification system. Every facility is different in the terms they use when describing the diet consistencies they provide to their residents/patients. If you or a loved one with dysphagia enter a health care facility and require a special diet consistency for foods and/or liquids, be certain to make the staff aware immediately and that the dietary department has been notified of the modifications needed.
It may be necessary to be vigilant to be certain appropriate departments have been notified and provide the correct diet consistency modifications over the early hours and even days of being admitted into a new setting.
Puréed Food Guidelines in the Home Setting:
It is assumed when a speech-language pathologist gets a referral to see an individual on a puréed diet that they will be receiving food that is smooth and free of lumps. However, not every individual on a puréed diet needs it to be this restricted.
Some individuals can tolerate a pureed food that has a grainy texture to it or tiny bits of food in it. For example, some individuals can tolerate oatmeal, others cannot.
This is where the need for a speech pathologist comes in. They will assess the etiology or root cause of the swallowing problem and work with the individual and/or caregivers to trial levels that are safe and can be tolerated within the confines of a puréed diet.
A speech pathologist will provide education and teaching on dysphagia. Teaching may cover compensatory safe swallowing strategies that may be effective, positioning or aids that may facilitate safer swallowing, and when or if re-evaluations are appropriate.
A speech pathologist can assist in teaching how to modify textures of various foods into a purée. This will help you prepare a greater variety of foods a person is eating for improved compliance of the diet consistency and health of the individual.
Conclusion:
Guidelines and the tests recommended by IDDSI help an individual and/or caregiver feel confident and comfortable in preparing puréed foods correctly. If you are struggling with what foods to purée and how to purée them talk with your primary care physician about a referral to work with a speech pathologist.
Best wishes, Jean
