MODIFIED DIETS: Dysphagia Part 2 (Solids)

 

Image: IDDSI Framework Chart, accessed from IDDSI.org 29 October 2025

MODIFIED DIETS: DYSPHAGIA PART 2 (SOLIDS)

By Flora Baker MS, EdM, RD, LDN and Gail K. Kachnycz RN, MSN 24 October 2025

     The goal of making modifications to the diet is to allow a person to safely consume and enjoy their food. If a person is having difficulty swallowing, small amounts of solid foods or liquids may be inhaled into the airways or lungs, a condition known as aspiration. If solid foods are not chewed sufficiently or swallowed completely, there is a risk of choking.

     This post targets general modifications for solid foods. The goal is to eliminate lumps and create a texture that is smooth and pudding-like. Some foods naturally have this consistency, or are easily prepared without special equipment. Examples are:

-Scrambled eggs

-Dairy products like cottage cheese (small curd), yogurt, custard, pudding

-Soft fruits such as mashed bananas, apple sauce, mashed avocado

-Cooked cereals such as oatmeal, grits, Cream of Wheat. Milk (dairy or oat/almond milk) can be added to create desired consistency.

     Some foods may require use of a blender or food processor to soften them. The University of Virginia School of Medicine recommends the following:

-Blended cooked protein (meat, fish, poultry, tofu, nut butters)

-Pureed beans, hummus

-Blended bananas, peaches, pears

-Blended cooked vegetables such as potatoes (white or sweet), peas, carrots, cauliflower, squash (acorn, butternut, spaghetti squash)

Adding sauces, broth, milk or gravy may enhance the flavor as well as help create a smooth, soft texture.

     What are some foods to avoid? In general, foods that are hard, dry, stringy, sticky or chunky. Examples include:

-Vegetables or fruits that have seeds, tough skins, or stringy fibers such as raw celery or mangoes.

-Dried fruit of any kind such as raisins, cranberries, dried apples

-Dried meat such as jerky.

-Fried foods, such as fish or chicken.

-Dry foods such as popcorn, nuts, hard cheeses

-Some bread products, even soft breads, may form a sticky chunk when exposed to saliva

     Since 2019, the standard for the dysphagia diet is the International Dysphagia Diet Standardisation Initiative (IDDSI). There are seven levels of food and liquids, ranging from a regular diet with all textures to liquids as thin as water. The medical provider may specify the particular level of texture for solids or liquids according to the IDDSI guidelines. The IDDSI website identifies and describes the textures and thickness for each level. Instructional videos are also available. These are helpful but the caregiver should clarify any questions with the medical provider.

Here is the link for IDDSI www.IDDSI.org 

From the Home Page, click “Resources” along the top of the screen. The drop-down menu includes “Patient Handouts” which give details of each level in the diet, and foods to avoid. “Videos” show exactly how to prepare and check if the food is the correct consistency.