CDRE - IDDSI

slighlty thick

• thicker than water
• requires a little more effort to drink than thin liquids
• flows through a straw, syringe, teat/nipple
• similar to the thickness of most comercially available 'anti-regurgitation' (AR) infant formulas

mildly thick

• flows off a spoon
• sippable pours quickly from a spoon but slower than thin drinks
• mild effort is required to drink this thickness through standard bore straw (Diameter=0.209 inch or 5.3 mm)

Two terms used: for foods we use term "liquidised" for drinks we use term "moderately thick"

• can be drunk from a cup
• moderate effort is required to suck through a standard bore straw or wide bore straw(wide=0.275 inch / 6.9mm)
• cannot be piped, layered or molded on a plate because it will not retain its shape
• cannot be eaten with a fork because it drips slowly in dollops through the prongs
• can be eaten with a spoon 
• no oral processing or chewing required (smooth texture, no 'bits')

We use two terms: for foods we use the term "pureed" and for liquids "extremely thick"

• Usually eaten with a spoon (a fork is possible)
• Cannot be drunk from a cup because it does not flow easily
• Cannot be sucked through a straw
• does not require chewing
• Can be piped, layered or molded because it retains its shape, but should not require chewing if presented in this form
• Shows some very slow movement under gravity but cannot be poured
• Falls off spoon in a single spoonful when tilted and continues to hold shape on a plate
• No lumps
• Not sticky
• Liquid must not separate from solid

minced & moist

• can be eaten with a fork or spoon
• could be eaten with chopsticks in some cases, if the individual has very good hand control
• can be scooped and shaped
• soft and moist with no separate thin liquid
• small lumps visible within food
  • PAEDIATRIC: equal to or less than 2mm with and no longer than 8mm in length
  • ADULT: equal to or less than 4mm with and no longer than 15mm in length
• lumps are easy to squash with tongue

Soft & bite-sized

• can be eaten with a fork, spoon or chopsticks
• can be mashed/broken down with pressure from fork, spoon or chopssticks
• a knife is not required to cut this food, but may be used to help load a fork or spoon
• soft, tender and moist thorughout but with no separate thin liquid
• chewing is required before swallowing
• 'bite-sized' pieces as appropriate for size and oral processing skills
  • paediatric, 8mm pieces (no larger than)
  • adults, 15mm pieces (no larger than)

Easy to chew

• normal, everyday foods of soft/tender textures
• any method that may be used to eat these foods
• sample size is not restricted at level 7, therefore, foods may be of a range of sizes
• does not include: hard, tough, chewy, fibrous, stringy, crunchy, or crumbly bits, pips, seeds, fibrous parts of fruit, husk or bones
• may include 'dual consistency' or 'mixed consistency' foods and liquids if also safe for level 0 and at clinician discretion.

In none: hard and crunchy foods are regular foods. IDDSI does categorize regular foods actually also into level 7, however the adapted IDDSI 7 is called easy to chew. 

As soon the person can eat hard, though, chewy, fibrous, stringy, dry, crispy, chunchy or crumbly bits usually no food restriction is required anymore (liquids still may do)

Foods that starts as one texture (e.g. firm solid) and changes into another texture specifically when moisture (e.g. water or saliva) is applied or when a change in temperature accurs.

IDDSI transitional foods may include and are not limited to:

• ice chips
• ice cream/sherbet
• Wafers (also includes religious communion wafer)
• waffle cones used to hold ice cream
• some biscuits/cookies/crackers
• some potato crisps - only ones made or formed from mashed potato (e.g Pringles)
• shortbread
• prawn crisps

It is a specific test for level 0,1,2,3. It tests how liquids flow through a syringe. 

We need a 10 mL syringe and a 10 second timer. 

To make sure that the syringe gives accurate results, the length of the 10 ml scale should be 61.5 mm. Alternativly we can also fill it with 10 mL of water. If the Syringe is empty in ~7 seconds.https://www.iddsi.org/videos/2-2-iddsi-flow-test-instructions

fill the 10 mL syringe with the liquid you want to text. After 10 seconds there still will be 1 to 4 ml of liquid in the syringe. 

Check out this video
1https://www.iddsi.org/videos/2-4-iddsi-flow-test-level-1

The 10 mL syringe will still contain 4-8 ml of liquid after 10 seconds of flow time.

https://www.iddsi.org/videos/2-5-iddsi-flow-test-level-2

If there is after 10 seconds of flow time, still 8-9.9 mL inside the syringe, it indicates that it is a moderately thick liquid.

We can also use the fork test: with the fork we try to get some of the liquid out of a cup. the liquid drips slowly or in dollops/strands though the slots of a fork. (usually if we test food if it reaches the 'liquidised' state.https://www.iddsi.org/videos/2-6-iddsi-tests-level-3-moderately-thick

In the flow test, level 4 is not leaving the syringe because it is too thick - usually only used when we over thicken a liquid and see that the 'extremely thick' liquid is not getting out of the syringe anymore. 

there are 4 other tests for level 4, pureed food: 

• fork pressure test: smooth, no lumps, minimal granulation. When fork is pressed on food, the tines/prongs ican make a clear pattern on the surface, and the food tetains the indentation from the fork
• fork drip test: sample sits in a mound/pile above the fork, a small amount may flow through and form a short tail below fork tines, but it does NOT flow or drip CONTINOUSLY through the prongs of a fork
• spoon tilt test: holds shape on spoon. A full spoonful must plop off the spoon if it is tilted. a very gentle flick may be necessary to dislodge the sample from spoon. A thin film remaining on the spoon after the tilt test is acceptable, however, you should still be able to see the spoon through the thin film. if it does not fall off, then it is too sticky/thick
• finger test (if no spoon or fork available): just possible to hold a sample in fingers. The testure slides smoothly and easily between fingers and leaves noticeable coating.https://www.iddsi.org/videos/2-8-iddsi-spoon-tilt-test-level-4-extremely-thick

There are 5 tests available for the minced & moiste consistency:

• fork pressure test: when pressed with fork the paricles should easily be separated between and come though the tines of a fork. can be easily mashed with little pressure from a fork - the pressure should NOT make the thumb nail blanch to white
• fork drip test: wen a sample is scooped, it sits in a pile or can mound on the fork and does not easily flow/fall through the tines of a fork. 
• spoon tilt test: cohesive enough to hold shape on spoon. A full spoonful must fall of the spoon if the spoon is tilted or turned sideways or shaken lightly. Sample should NOT be sticky
• Chopstick test: chopsticks can be used to scoop or hold this texture if the sample is moist and cohesive and the person has very good hand control to use chopssticks
• finger test: it is possible to easily holf a sample using fingers; small, soft, smooth, rounded particles can be easily separated using fingers. the material feel moist and leave fingers wet

https://www.iddsi.org/videos/2-9-iddsi-tests-level-5-minced-and-moist