&''(&%)*+,-.

/*0%
!-$5#1C%J-5"/2$%

!"#$%&''(&%)*+,-./*0%+12%'-$3*#45/*$%+*-%6#3-1$-2%712-*%5"-%%
8*-+5#9-8/,,/1$%:55*#;75#/1<("+*-+6#0-%=>?%&15-*1+5#/1+6%@#3-1$-%%
"554$ABB3*-+5#9-3/,,/1$>/*CB6#3-1$-$B;D<$+B=>?B%
E35/;-*%F?G%H?FI%
!
 INTRODUCTION  

The  International  Dysphagia  Diet  Standardisation  Initiative  (IDDSI)  was  founded  in  2013  with  the  goal  of  
developing  new  global  standardised  terminology  and  definitions  to  describe  texture  modified  foods  and  
thickened  liquids  used  for  individuals  with  dysphagia  of  all  ages,  in  all  care  settings,  and  all  cultures.  

Three  years  of  ongoing  work  by  the  International  Dysphagia  Diet  Standardisation  Committee  has  
culminated  in  a  final  dysphagia  diet  framework  consisting  of  a  continuum  of  8  levels  (0-­‐7).  Levels  are  
identified  by  numbers,  text  labels  and  colour  codes.    

This  document  provides  details  regarding  Testing  Methods  for  use  with  the  IDDSI  Framework.    

This  document  is  to  be  read  in  conjunction  with  the  Complete  IDDSI  Framework,  IDDSI  Evidence  and  
IDDSI  Frequently  Asked  Questions  (FAQs)  documents  (http://iddsi.org/resources/framework/).  

The  IDDSI  Committee  would  like  to  acknowledge  the  interest  and  participation  of  the  global  community  
including  patients,  caregivers,  health  professionals,  industry,  professional  associations  and  researchers.  
We  would  also  like  to  thank  our  sponsors  for  their  generous  support.  

Please  visit  the  www.iddsi.org  for  further  information  

The  IDDSI  Committee:  

Co-­‐Chairs:  Peter  Lam  (CAN)  &  Julie  Cichero  (AUS);    

Committee  Members:  Jianshe  Chen  (CHN),  Roberto  Dantas  (BRA),  Janice  Duivestein  (CAN),  Ben  Hanson  (UK),  Jun  
Kayashita  (JPN),  Caroline  Lecko  (UK),  Mershen  Pillay  (ZAF),  Luis  Riquelme  (USA),  Soenke  Stanschus  (GER),  Catriona  
Steele  (CAN).  

Past  Committee  Members:  Joe  Murray  (USA)  

The  International  Dysphagia  Diet  Standardisation  Initiative  Inc.  (IDDSI)  is  an  independent,  not-­‐for-­‐profit  entity.  
IDDSI  is  grateful  to  a  large  number  of  agencies,  organizations  and  industry  partners  for  financial  and  other  
support.  Sponsors  have  not  been  involved  with  the  design  or  development  of  the  IDDSI  framework.  

Development  of  the  IDDSI  framework  (2012-­‐2015)    

IDDSI  would  like  to  thank  and  acknowledge  the  following  sponsors  for  their  generous  support  in  the  development  
of  the  IDDSI  framework:    
• Nestlé  Nutrition  Institute  (2012-­‐2015)  
• Nutricia  Advanced  Medical  Nutrition  (2013-­‐2014)  
• Hormel  Thick  &  Easy  (2014-­‐2015)  
• Campbell’s  Food  Service  (2013-­‐2015)  
• apetito  (2013-­‐2015)  
• Trisco  (2013-­‐2015)  
• Food  Care  Co.  Ltd.  Japan  (2015)  
• Flavour  Creations  (2013-­‐2015)  
• Simply  Thick  (2015)  
• Lyons  (2015)  
 
Implementation  of  the  IDDSI  framework  is  in  progress.    IDDSI  is  extremely  grateful  to  all  sponsors  supporting  
implementation  http://iddsi.org/about-­‐us/sponsors/  

The  IDDSI  Framework  and  Descriptors  are  licensed  under  the     2  

CreativeCommons  Attribution-­‐Sharealike  4.0  International  License    
https://creativecommons.org/licenses/by-­‐sa/4.0/  
October  10,  2016  
!-$5#1C%J-5"/2$%K/*%7$-%.#5"%5"-%%
&''(&%)*+,-./*0%
%
!"-%&''(&%$D$5-,+5#3%*-9#-.%$7CC-$5-2%5"+5%6#Z7#2$%+12%K//2%$"/762%;-%36+$$#K#-2%#1%5"-%3/15-b5%/K%5"-%
4"D$#/6/C#3+6%4*/3-$$-$%#19/69-2%#1%/*+6%4*/3-$$#1CG%/*+6%5*+1$4/*5%+12%K6/.%#1#5#+5#/1>%!/%5"#$%-12G%
2#KK-*-15%2-9#3-$%+*-%1--2-2%5/%;-$5%2-$3*#;-%5"-%;-"+9#/7*%/K%5"-%;/67$%N(5--6-%-5%+6>G%H?F^P>%%

'*#10$%+12%/5"-*%6#Z7#2$%
:337*+5-%,-+$7*-,-15%/K%K67#2%K6/.%4*/4-*5#-$%#$%+%3/,46-b%5+$0>%!/%2+5-G%;/5"%*-$-+*3"%+12%-b#$5#1C%
1+5#/1+6%5-*,#1/6/C#-$G%"+9-%$572#-2%/*%*-3/,,-12-2%5"-%36+$$#K#3+5#/1%/K%2*#10$%;+$-2%/1%9#$3/$#5D>%%
U/.-9-*G%9#$3/$#5D%,-+$7*-,-15%#$%1/5%+33-$$#;6-%5/%,/$5%36#1#3#+1$%/*%3+*-C#9-*$>%%

)7*5"-*,/*-G%9#$3/$#5D%#$%1/5%5"-%/16D%*-6-9+15%4+*+,-5-*A%5"-%K6/.%/K%+%2*#10%+$%#5%#$%3/1$7,-2%#$%
#1K67-13-2%;D%,+1D%/5"-*%9+*#+;6-$%#13672#1C%2-1$#5DG%D#-62%$5*-$$G%5-,4-*+57*-G%4*/476$#/1%4*-$$7*-%+12%
K+5%3/15-15%NEa@-+*D%-5%+6>G%H?F?T%(/4+2-%-5%+6>G%H??cG%(/4+2-%-5%+6>G%H??d+G;T%U+22-%-5%+6>H?F^+G;P>%!"-%
$D$5-,+5#3%*-9#-.%2-,/1$5*+5-2%.#2-%9+*#+;#6#5D%#1%5-$5#1C%5-3"1#Z7-$%7$-2%+12%K/712%5"+5%/5"-*%0-D%
4+*+,-5-*$%$73"%+$%$"-+*%*+5-$G%$+,46-%5-,4-*+57*-G%2-1$#5D%+12%D#-62%$5*-$$%.-*-%*+*-6D%*-4/*5-2%
N(5--6-%-5%+6>G%H?F^T%8#3"-*/%-5%+6>G%H?F`P>%'*#10$%5"#30-1-2%.#5"%2#KK-*-15%5"#30-1#1C%+C-15$%,+D%"+9-%5"-%
$+,-%,-+$7*-,-15%/K%+44+*-15%9#$3/$#5D%+5%/1-%4+*5#376+*%$"-+*%*+5-G%+12%D-5%"+9-%9-*D%2#KK-*-15%K6/.%
3"+*+35-*#$5#3$%#1%4*+35#3-%N(5--6-%-5%+6>%H?F^T%Ea@-+*D%-5%+6>GH?F?T%)71+,#%-5%+6>G%H?FHT%:$"#2+%-5%+6>G%
H??cT%[+*3#+%-5%+6>G%H??^P>%%&1%+22#5#/1%5/%9+*#+5#/1$%#1%K6/.%+$$/3#+5-2%.#5"%2*#10%3"+*+35-*#$5#3$G%K6/.%
*+5-$%27*#1C%$.+66/.#1C%+*-%-b4-35-2%5/%2#KK-*%2-4-12#1C%/1%+%4-*$/1a$%+C-%+12%6-9-6%/K%#,4+#*,-15%/K%
$.+66/.#1C%K7135#/1%NEa@-+*D%-5%+6>G%H?F?P>%

)/*%5"-$-%*-+$/1$G%+%,-+$7*-,-15%/K%9#$3/$#5D%"+$%!"#%;--1%#13672-2%#1%5"-%&''(&%2-$3*#45/*$>%&1$5-+2G%+%
C*+9#5D%K6/.%5-$5%7$#1C%+%F?%,@%$6#4%5#4%$D*#1C-%#$%*-3/,,-12-2%5/%Z7+15#KD%5"-%6#Z7#2a$%K6/.%3+5-C/*D%
N$+,46-%*-,+#1#1C%K*/,%F?%,@%+K5-*%F?%$-3%/K%K6/.P>%!"-%3/15*/66-2%3/12#5#/1$%+*-%;*/+26D%
*-4*-$-15+5#9-%/K%2*#10#1C%5"*/7C"%+%$5*+.%/*%;-+0-*>%%

!"-%&''(&%)6/.%5-$5%#$%+6$/%$#,#6+*%#1%2-$#C1%+12%,-+$7*-,-15%4*#13#46-$%5/%5"-%M/$5"7,7$%)711-6%5"+5%#$%
7$-2%#1%5"-%2+#*D%#127$5*D%5/%,-+$7*-%6#Z7#2%5"#301-$$%N9+1%e6#-5G%H??HT%X755-*%-5%+6>G%H?FFP>%&1%K+35%5"-%
M/$5"7,7$%K711-6%6//0$%6#0-%+%6+*C-%$D*#1C-%N9+1%e6#-5G%H??HT%X755-*%-5%+6>G%H?FFP>%J-+$7*-$%5+0-1%7$#1C%
5"-%M/$5"7,7$%K711-6%#13672-%5"-%5#,-%K/*%+%$4-3#K#-2%+,/715%/K%$+,46-%5/%K6/.G%+12%,+$$%6-K5%+K5-*%+%
2-K#1-2%4-*#/2%/K%K6/.>%%e+1%e6#-5%NH??HP%1/5-$%5"+5%5"-%C-/,-5*D%/K%5"-%M/$5"7,7$%K711-6%3/15+#1$%+%
$"-+*%+12%-6/1C+5#/1%3/,4/1-15%5"+5%,/*-%36/$-6D%,+53"-$%K6/.%3/12#5#/1$%.#5"#1%5"-%/*+6%3+9#5D>%%

:65"/7C"%5"-%$D*#1C-%3"/$-1%K/*%7$-%.#5"%5"-%&''(&%)6/.%5-$5%#$%$#,46-G%5"-%5-$5%"+$%;--1%K/712%5/%
3+5-C/*#$-%+%.#2-%*+1C-%/K%6#Z7#2$%*-6#+;6DG%+12%#1%+C*--,-15%.#5"%37**-156D%-b#$5#1C%6+;/*+5/*D%5-$5$%+12%
-b4-*5%f72C-,-15>%%&5%"+$%+6$/%;--1%K/712%5/%;-%$-1$#5#9-%-1/7C"%5/%2-,/1$5*+5-%$,+66%3"+1C-$%#1%
5"#301-$$%+$$/3#+5-2%.#5"%3"+1C-%#1%$-*9#1C%5-,4-*+57*->%%

!"-%&''(&%)*+,-./*0%+12%'-$3*#45/*$%+*-%6#3-1$-2%712-*%5"-%% #!
8*-+5#9-8/,,/1$%:55*#;75#/1<("+*-+6#0-%=>?%&15-*1+5#/1+6%@#3-1$-%%
"554$ABB3*-+5#9-3/,,/1$>/*CB6#3-1$-$B;D<$+B=>?B%
E35/;-*%F?G%H?FI%
IDDSI  Flow  Test  
The  IDDSI  Flow  test  uses  a  10  mL  slip  tip  hypodermic  syringe,  as  shown  in  the  image  below.    

Although  10  mL  syringes  were  initially  thought  to  be  identical  throughout  the  world  based  on  reference  
to  an  ISO  standard  (ISO  7886-­‐1),  it  has  subsequently  been  determined  that  the  ISO  document  refers  only  
to  the  nozzle  of  the  syringe  and  that  variability  in  barrel  length  and  dimensions  may  exist  between  
brands.  Specifically  the  IDDSI  Flow  test  uses  a  reference  syringe  with  a  measured  length  of  61.5  mm  
from  the  zero  line  to  the  10  mL  line  (BDTM  syringes  were  used  for  the  development  of  the  tests  –  
manufacturer  code  301604).  IDDSI  is  aware  that  there  are  some  syringes  that  are  labeled  as  10  mL,  but  
in  fact  have  a  12  mL  capacity.    Results  using  a  12  mL  syringe  will  be  different  to  those  from  a  true  10  mL  
syringe.    As  a  result  it  is  important  to  check  the  barrel  length  as  shown  on  the  diagram  below.  Details  for  
conducting  the  test  are  shown  below.  

Videos  showing  the  IDDSI  Flow  Test  can  also  be  viewed  at:    http://iddsi.org/framework/drink-­‐testing-­‐
methods/    

Drinks  and  liquids  such  as  gravy,  sauces  and  nutritional  supplements  are  best  assessed  using  the  IDDSI  
Flow  Test  (Levels  0-­‐3).    For  extremely  thick  drinks  (Level  4),  that  do  not  flow  through  a  10  mL  syringe  in  
10  seconds  and  are  best  consumed  with  a  spoon,  the  IDDSI  Fork  Test  and/or  Spoon  Tilt  Test  are  
recommended  as  methods  for  determining  consistency.  

The  IDDSI  Framework  and  Descriptors  are  licensed  under  the     4  

CreativeCommons  Attribution-­‐Sharealike  4.0  International  License    
https://creativecommons.org/licenses/by-­‐sa/4.0/  
October  10,  2016  
 The  IDDSI  Framework  and  Descriptors  are  licensed  under  the     5  
CreativeCommons  Attribution-­‐Sharealike  4.0  International  License    
https://creativecommons.org/licenses/by-­‐sa/4.0/  
October  10,  2016  
 The  IDDSI  Framework  and  Descriptors  are  licensed  under  the     6  
CreativeCommons  Attribution-­‐Sharealike  4.0  International  License    
https://creativecommons.org/licenses/by-­‐sa/4.0/  
October  10,  2016  
)//2$%
V-$-+*3"%5/%2+5-%#1%5"-%+*-+%/K%K//2%5-b57*-%,-+$7*-,-15%*-Z7#*-$%3/,46-b%+12%-b4-1$#9-%,+3"#1-*D%
$73"%+$%)//2%!-b57*-%:1+6D$-*$>%[#9-1%5"-%2#KK#3765D%.#5"%+33-$$%5/%$73"%-Z7#4,-15%+12%5"-%-b4-*5#$-%
*-Z7#*-2%K/*%5-$5#1C%+12%#15-*4*-5+5#/1G%,+1D%-b#$5#1C%1+5#/1+6%5-*,#1/6/C#-$%"+9-%7$-2%2-5+#6-2%
2-$3*#45/*$%5/%2-$3*#;-%K//2%5-b57*-%#1$5-+2>%
%
!"-%$D$5-,+5#3%*-9#-.%2-,/1$5*+5-2%5"+5%5"-%4*/4-*5#-$%/K%"+*21-$$G%3/"-$#9-1-$$%+12%$6#44-*#1-$$%
.-*-%#,4/*5+15%K+35/*$%K/*%3/1$#2-*+5#/1%N(5--6-%-5%+6>G%H?F^P>%&1%+22#5#/1G%$#]-%+12%$"+4-%/K%K//2%
$+,46-$%"+9-%;--1%#2-15#K#-2%+$%*-6-9+15%K+35/*$%K/*%3"/0#1C%*#$0%NX-11-2D%-5%+6>G%H?F=T%8"+4#1%-5%+6>G%
H?F`T%R+4+1-$-%)//2%(+K-5D%8/,,#$$#/1G%H?F?T%J/*6-D%-5%+6>G%H??=T%J7%-5%+6>G%FhhFT%W-*]6+1/9#3"%-5%+6>%
FhhhT%L/6+3"%-5%+6>G%Fhh=T%8-15*-%K/*%'#$-+$-%8/15*/6%+12%M*-9-15#/1G%H??HG%V#,,-66%-5%+6>G%Fhh^T%(-#2-6%
-5%+6>G%H??HP>%
%
&1%9#-.%/K%5"#$%#1K/*,+5#/1G%,-+$7*-,-15%/K%K//2$%1--2$%5/%3+457*-%;/5"%5"-%,-3"+1#3+6%4*/4-*5#-$%
N->C>%"+*21-$$G%3/"-$#9-1-$$G%+2"-$#9-1-$$%-53>P%+12%5"-%C-/,-5*#3+6%/*%$"+4-%+55*#;75-$%/K%5"-%K//2>%
!"-%&''(&%2-$3*#45#/1$%/K%K//2%5-b57*-%+12%3"+*+35-*#$5#3$G%K//2%5-b57*-%*-Z7#*-,-15$%+12%*-$5*#35#/1$%
"+9-%;--1%C-1-*+5-2%K*/,%-b#$5#1C%1+5#/1+6%5-*,#1/6/C#-$%+12%5"-%6#5-*+57*-%2-$3*#;#1C%4*/4-*5#-$%5"+5%
#13*-+$-%*#$0%K/*%3"/0#1C>%%
%
:%3/,;#1+5#/1%/K%5-$5$%,+D%;-%*-Z7#*-2%5/%2-5-*,#1-%."#3"%3+5-C/*D%+%K//2%K#5$%#15/>%%!-$5#1C%,-5"/2$%
K/*%47*--$G%$/K5G%K#*,%+12%$/6#2%K//2$%#13672-A%!"-%)/*0%'*#4%5-$5G%(4//1%!#65%5-$5G%)/*0%/*%(4//1%M*-$$7*-%
!-$5G%8"/4$5#30%!-$5%+12%)#1C-*%5-$5>%e#2-/$%$"/.#1C%-b+,46-$%/K%5"-$-%5-$5#1C%,-5"/2$%3+1%;-%K/712%+5A!
"554ABB#22$#>/*CBK*+,-./*0BK//2<5-$5#1C<,-5"/2$B
%
%%%
)/*0%'*#4%!-$5)
!"#30%2*#10$%+12%K67#2%K//2$%N@-9-6$%`%+12%=P%3+1%;-%5-$5-2%;D%+$$-$$#1C%."-5"-*%5"-D%K6/.%5"*/7C"%5"-%
$6/5$B4*/1C$%/K%+%K/*0%+12%3/,4+*#1C%+C+#1$5%5"-%2-5+#6-2%2-$3*#45#/1$%/K%-+3"%6-9-6>%)/*0%2*#4%5-$5$%+*-%
2-$3*#;-2%#1%-b#$5#1C%O+5#/1+6%5-*,#1/6/C#-$%#1%:7$5*+6#+G%&*-6+12G%O-.%Y-+6+12%+12%5"-%S1#5-2%X#1C2/,%
N:5"-*5/1%-5%+6>G%H??cT%&:(@!%+12%&*#$"%O75*#5#/1%Q%'#-5-5#3%&1$5#575-%H??hT%O+5#/1+6%M+5#-15%(+K-5D%
:C-13DG%V/D+6%8/66-C-%(4--3"%Q%@+1C7+C-%!"-*+4#$5$G%W*#5#$"%'#-5-5#3%:$$/3#+5#/1G%O+5#/1+6%O7*$-$%
O75*#5#/1%[*/74G%U/$4#5+6%8+5-*-*$%:$$/3#+5#/1%H?FFP>%%
%
&,+C-$%K/*%@-9-6%`%<%@#Z7#2#$-2BJ/2-*+5-6D%!"#30%+*-%$"/.1%;-6/.>%
%
%
%
)
)
)
()*+,!,-./-0!.)!*1!
) 2.--.+,3,4)512,!46).786!469!
) 4*19,3+).18,!.:!5!:.);!

)
)
)
)
!"-%&''(&%)*+,-./*0%+12%'-$3*#45/*$%+*-%6#3-1$-2%712-*%5"-%% '!
8*-+5#9-8/,,/1$%:55*#;75#/1<("+*-+6#0-%=>?%&15-*1+5#/1+6%@#3-1$-%%
"554$ABB3*-+5#9-3/,,/1$>/*CB6#3-1$-$B;D<$+B=>?B%
E35/;-*%F?G%H?FI%
&,+C-$%K/*%@-9-6%=%<%M7*--2B\b5*-,-6D%!"#30%+*-%$"/.1%;-6/.>%
)
)
)
(#5$%#1%+%,/712%/*%
4#6-%+;/9-%5"-%K/*0% )
)
)

)
)
)
:%$,+66%+,/715%,+D%K6/.%5"*/7C"%+12%K/*,%+%5+#6%;-6/.%5"-%K/*0%
)
'/-$%1/5%2/66/4G%K6/.%/*%2*#4%3/15#17/7$6D%5"*/7C"%5"-%K/*0%4*/1C$% )
)
)
)
)
(4//1%!#65%!-$5%
!"-%$4//1%5#65%5-$5%#$%7$-2%5/%2-5-*,#1-%5"-%$5#30#1-$$%/K%5"-%$+,46-%N+2"-$#9-1-$$P%+12%5"-%+;#6#5D%/K%5"-%
$+,46-%5/%"/62%5/C-5"-*%N3/"-$#9-1-$$P>%!"-%(4//1%!#65%!-$5%#$%2-$3*#;-2%#1%-b#$5#1C%O+5#/1+6%
5-*,#1/6/C#-$%#1%:7$5*+6#+G%&*-6+12G%O-.%Y-+6+12%+12%5"-%S1#5-2%X#1C2/,%N:5"-*5/1%-5%+6>G%H??cT%&:(@!%
+12%&*#$"%O75*#5#/1%Q%'#-5-5#3%&1$5#575-%H??hT%O+5#/1+6%M+5#-15%(+K-5D%:C-13DG%V/D+6%8/66-C-%(4--3"%Q%
@+1C7+C-%!"-*+4#$5$G%W*#5#$"%'#-5-5#3%:$$/3#+5#/1G%O+5#/1+6%O7*$-$%O75*#5#/1%[*/74G%U/$4#5+6%8+5-*-*$%
:$$/3#+5#/1%H?FFP>%
%
!"-%(4//1%!#65%!-$5%#$%7$-2%4*-2/,#1+156D%K/*%,-+$7*-$%/K%$+,46-$%#1%6-9-6$%=%+12%^>%!"-%$+,46-%$"/762A%
• W-%3/"-$#9-%-1/7C"%5/%"/62%#5$%$"+4-%/1%5"-%$4//1%
• :%K766%$4//1K76%,7$5%$6#2-B4/7*%/KK%5"-%$4//1%#K%5"-%$4//1%#$%5#65-2%/*%57*1-2%$#2-.+D$%/*%$"+0-1%
6#C"56DT%5"-%$+,46-%$"/762%$6#2-%/KK%-+$#6D%.#5"%9-*D%6#556-%K//2%6-K5%/1%5"-%$4//1T%#>->%5"-%$+,46-%
$"/762%1/5%;-%$5#30D%
• :%$3//4-2%,/712%,+D%$4*-+2%/*%$67,4%9-*D%$6#C"56D%/1%+%46+5-)

)
)
)
)
!"-%&''(&%)*+,-./*0%+12%'-$3*#45/*$%+*-%6#3-1$-2%712-*%5"-%% <!
8*-+5#9-8/,,/1$%:55*#;75#/1<("+*-+6#0-%=>?%&15-*1+5#/1+6%@#3-1$-%%
"554$ABB3*-+5#9-3/,,/1$>/*CB6#3-1$-$B;D<$+B=>?B%
E35/;-*%F?G%H?FI%
(/K5G%K#*,%+12%"+*2%K//2%5-b57*-%+$$-$$,-15)
)/*%$/K5G%"+*2%/*%K#*,%K//2G%5"-%K/*0%"+$%;--1%3"/$-1%5/%+$$-$$%K//2%5-b57*-%+$%#5%3+1%71#Z7-6D%;-%7$-2%
K/*%+$$-$$,-15%/K%,-3"+1#3+6%4*/4-*5#-$%+$$/3#+5-2%.#5"%"+*21-$$G%#1%+22#5#/1%5/%
+$$-$$,-15%/K%$"+4-%+55*#;75-$%$73"%+$%4+*5#36-%$#]->%%
%
%
:$$-$$#1C%K/*%=,,%4+*5#36-%$#]-%3/,46#+13-%%
)/*%+2765$G%5"-%+9-*+C-%4+*5#36-%$#]-%/K%3"-.-2%$/6#2$%K//2$%;-K/*-%$.+66/.#1C%
,-+$7*-$%H<=%,,%NM-D*/1%-5%+6>G%H??=T%L/2+%-5%+6>G%H?F?P>%!"-%$6/5$BC+4$%
;-5.--1%5"-%5#1-$B4*/1C$%/K%+%$5+12+*2%,-5+6%K/*0%5D4#3+66D%,-+$7*-%=%,,G%
."#3"%4*/9#2-$%+%7$-K76%3/,46#+13-%,-+$7*-%K/*%4+*5#36-%$#]-%/K%K//2$%+5%@-9-6%^% <%
J#13-2%Q%J/#$5>%)/*%2-5-*,#1#1C%4+*5#36-%$#]-%$+K-5D%K/*%#1K+15$G%$+,46-$%5"+5%
+*-%$,+66-*%5"+1%5"-%,+b#,7,%.#25"%/K%5"-%3"#62a$%K#K5"%K#1C-*1+#6%N6#556-$5%K#1C-*P%
$"/762%1/5%3+7$-%+%3"/0#1C%*#$0%+$%5"#$%,-+$7*-,-15%#$%7$-2%5/%4*-2#35%5"-%
#15-*1+6%2#+,-5-*%/K%+1%-12/5*+3"-+6%57;-%#1%5"-%4+-2#+5*#3%4/476+5#/1%N!7*0#$5+1#%-5%+6>G%H??hP>)
%
%
!! %
%
8/,46#+13-%.#5"%=,,%4+*5#36-%$#]-%3+1%;-%2-,/1$5*+5-2%
.#5"%+%K/*0%+$%$"/.1%#1%5"-%#,+C-$%/44/$#5->%
%
%
"! %
%
%
%
%

:$$-$$#1C%K/*%F^,,%NF>^3,P%4+*5#36-%$#]-%3/,46#+13-%
)/*%"+*2%+12%$/K5%$/6#2%K//2$G%+%,+b#,7,%K//2%$+,46-%$#]-%/K%F>^%b%F>^%3,%#$%*-3/,,-12-2G%."#3"%#$%5"-%
+44*/b#,+5-%$#]-%/K%5"-%+2765%"7,+1%5"7,;%1+#6%NJ7*2+1G%H?FFP>%!"-%-15#*-%.#25"%/K%+%$5+12+*2%K/*0%
+6$/%,-+$7*-$%+44*/b#,+5-6D%F>^3,%+$%$"/.1%#1%5"-%#,+C-$%;-6/.>%F>^%b%F>^%3,%4+*5#36-%$#]-%#$%
*-3/,,-12-2%K/*%@-9-6%I < (/K5%Q%W#5-<$#]-2%5/%*-273-%*#$0%+$$/3#+5-2%.#5"%+$4"Db#+5#/1%K*/,%3"/0#1C%/1%
K//2%NW-*]6+1/9#3"%-5%+6>G%H??^T%W/*2$0D%-5%+6>G%FhhIT%@#5,+1%-5%+6>G%H??`P>%
%
%
%
%
%
%
%

%
%
%
!"-%&''(&%)*+,-./*0%+12%'-$3*#45/*$%+*-%6#3-1$-2%712-*%5"-%% =!
8*-+5#9-8/,,/1$%:55*#;75#/1<("+*-+6#0-%=>?%&15-*1+5#/1+6%@#3-1$-%%
"554$ABB3*-+5#9-3/,,/1$>/*CB6#3-1$-$B;D<$+B=>?B%
E35/;-*%F?G%H?FI%
)/*0%M*-$$7*-%!-$5%+12%(4//1%M*-$$7*-%!-$5%
%
:%K/*0%3+1%;-%+446#-2%5/%5"-%K//2%$+,46-%5/%/;$-*9-%#5$%;-"+9#/7*%."-1%
4*-$$7*-%#$%+446#-2>%M*-$$7*-%+446#-2%5/%5"-%K//2%$+,46-%"+$%;--1%
Z7+15#K#-2%;D%+$$-$$,-15%/K%5"-%4*-$$7*-%1--2-2%5/%,+0-%5"-%5"7,;%1+#6%
;6+13"%1/5#3-+;6D%5/%."#5-G%+$%2-,/1$5*+5-2%;D%5"-%+**/.$%#1%5"-%#,+C-%
+5%6-K5>%%
%
%%
%
!"-%4*-$$7*-%+446#-2%5/%,+0-%5"-%5"7,;%1+#6%;6+13"%"+$%;--1%,-+$7*-2%
+5%i%Fc%0M+>%!"#$%4*-$$7*-%#$%3/1$#$5-15%.#5"%5/1C7-%K/*3-%7$-2%27*#1C%
$.+66/.#1C%N(5--6-%-5%+6>G%H?F=P>%&1%5"-%#,+C-%+5%*#C"5G%4*-$$7*-%#$%;-#1C%
2-,/1$5*+5-2%#1%0#6/4+$3+6$%7$#1C%+1%&/.+%E*+6%M-*K/*,+13-%&1$5*7,-15>%
!"#$%#$%/1-%2-9#3-%5"+5%3+1%;-%7$-2%5/%,-+$7*-%5/1C7-%4*-$$7*->%
%
% &,+C-%7$-2%.#5"%4-*,#$$#/1%;D%&EM&%J-2#3+6%
%
)/*%+$$-$$,-15%7$#1C%5"-%)/*0%M*-$$7*-%!-$5G%#5%#$%*-3/,,-12-2%5"+5%5"-%K/*0%
;-%4*-$$-2%/15/%5"-%K//2%$+,46-%;D%46+3#1C%5"-%5"7,;%/15/%5"-%;/.6%/K%5"-%
K/*0%Nf7$5%;-6/.%5"-%4*/1C$P%715#6%;6+13"#1C%#$%/;$-*9-2G%+$%$"/.1%#1%5"-%
#,+C-%+5%6-K5>%&5%#$%+44*-3#+5-2%5"+5%K/*0$%+*-%1/5%*-+2#6D%+9+#6+;6-%#1%$/,-%
4+*5$%/K%5"-%./*62>%M*-$$7*-%+446#-2%7$#1C%5"-%;+$-%/K%+%5-+$4//1%,+D%
4*/9#2-%+%7$-K76%+65-*1+5#9->%
%
%
8"/4$5#30%!-$5%+12%)#1C-*%5-$5%
:$$-$$,-15%.#5"%3"/4$5#30$%"+$%;--1%#13672-2%#1%5"-%&''(&>%)#1C-*%5-$5$%"+9-%;--1%#13/*4/*+5-2%#1%
*-3/C1#5#/1%5"+5%5"#$%,+D%;-%5"-%,/$5%+33-$$#;6-%,-5"/2%#1%$/,-%3/715*#-$>%%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
!"-%&''(&%)*+,-./*0%+12%'-$3*#45/*$%+*-%6#3-1$-2%712-*%5"-%% >?!
8*-+5#9-8/,,/1$%:55*#;75#/1<("+*-+6#0-%=>?%&15-*1+5#/1+6%@#3-1$-%%
"554$ABB3*-+5#9-3/,,/1$>/*CB6#3-1$-$B;D<$+B=>?B%
E35/;-*%F?G%H?FI%
!*+1$#5#/1+6%K//2%5-b57*-%+$$-$$,-15%
!*+1$#5#/1+6%K//2%5-b57*-$%+*-%5"/$-%5"+5%$5+*5%+$%/1-%5-b57*-%N->C>%K#*,%$/6#2P%+12%3"+1C-%#15/%+1/5"-*%
5-b57*-%$4-3#K#3+66D%."-1%,/#$57*-%N->C>%.+5-*%/*%$+6#9+P%#$%+446#-2G%/*%."-1%+%3"+1C-%#1%5-,4-*+57*-%
/337*$%N->C>%"-+5#1CP>%%!"#$%K//2%5-b57*-%#$%7$-2%#1%2-9-6/4,-15+6%5-+3"#1C%/*%*-"+;#6#5+5#/1%/K%3"-.#1C%
$0#66$>%)/*%-b+,46-%#5%"+$%;--1%7$-2%#1%5"-%2-9-6/4,-15%/K%3"-.#1C%#1%5"-%4+-2#+5*#3%4/476+5#/1%+12%
2-9-6/4,-15+6%2#$+;#6#5D%4/476+5#/1%N[#$-6%FhhFT%'/9-D%-5%+6>G%H?F`P>%
%
!/%+$$-$$%."-5"-*%+%$+,46-%K#5$%5"-%2-K#1#5#/1%/K%+%5*+1$#5#/1+6%K//2G%5"-%K/66/.#1C%,-5"/2%#$%+446#-2A%
%
S$-%+%$+,46-%5"-%$#]-%/K%5"-%5"7,;%1+#6%NF>^%3,%b%F>^%3,PG%46+3-%F%,6%/K%.+5-*%/1%5"-%$+,46-%+12%.+#5%
/1-%,#175->%:446D%K/*0%4*-$$7*-%7$#1C%5"-%;+$-%/K%5"-%K/*0%715#6%5"-%5"7,;1+#6%;6+13"-$%5/%."#5->%!"-%
$+,46-%#$%+%5*+1$#5#/1+6%K//2%5-b57*-%#K%+K5-*%*-,/9#1C%5"-%K/*0%4*-$$7*-A%
• !"-%$+,46-%"+$%;--1%$Z7+$"-2%+12%2#$#15-C*+5-2%+12%1/%6/1C-*%6//0$%6#0-%#5$%/*#C#1+6%$5+5-%."-1%5"-%
K/*0%#$%6#K5-2%
• !"-%$+,46-%3+1%;-%-+$#6D%;*/0-1%+4+*5%7$#1C%3"/4$5#30$%.#5"%,#1#,+6%4*-$$7*->%
• !"-%$+,46-%;*-+0$%+4+*5%3/,46-5-6D%;D%*7;;#1C%5"-%$+,46-%;-5.--1%5"-%5"7,;%+12%#12-b%K#1C-*%+12%
2/-$%1/5%*-57*1%5/%#5$%#1#5#+6%$"+4->%
• E*%#5%"+$%,-65-2%$#C1#K#3+156D%+12%1/%6/1C-*%6//0$%6#0-%#5$%/*#C#1+6%$5+5-%N->C>%#3-%3"#4$P>%
%
%
%
• :446D%F%,6%/K%.+5-*%5/%$+,46-% %
• L+#5%F%,#175-%
%
%

!"7,;%1+#6%;6+13"-2% %
5/%."#5-% %
%
%

(+,46-%$Z7+$"-$%+12%K*+357*-$G%
+12%2/-$%1/5%*-57*1%5/%#5$%/*#C#1+6%
$"+4-%."-1%4*-$$7*-%#$%*-6-+$-2!

%
)757*-%$572#-$%
)7*5"-*%./*0%#$%*-Z7#*-2%5/%2-9-6/4%+1%#1-b4-1$#9-%;75%+337*+5-%5//6%5/%+$$#$5%.#5"%K//2%5-b57*-%+1+6D$#$>%

2344-.5678/79):-4;.+70<)=*0051>>/::</?-@9>A@6.+B-@C>D1)
! &''(&%!-$5#1C%J-5"/2$%
! &''(&%\9#2-13-%
! &''(&%)*-Z7-156D%:$0-2%j7-$5#/1$%N):j$P%

!
!
!"-%&''(&%)*+,-./*0%+12%'-$3*#45/*$%+*-%6#3-1$-2%712-*%5"-%% >>!
8*-+5#9-8/,,/1$%:55*#;75#/1<("+*-+6#0-%=>?%&15-*1+5#/1+6%@#3-1$-%%
"554$ABB3*-+5#9-3/,,/1$>/*CB6#3-1$-$B;D<$+B=>?B%
E35/;-*%F?G%H?FI%
References  
Ashida  I,  Iwamori  H,  Kawakami  SY,  Miyaoka  Y,  Murayama  A.  Analysis  of  physiological  parameters  of  masseter  
muscle  activity  during  chewing  of  agars  in  healthy  young  males.  J  Texture  Stud.  2007;38:87–99.  
 
Atherton  M,  Bellis-­‐Smith  N,  Cichero  JAY,  Suter  M.  Texture  modified  foods  and  thickened  fluids  as  used  for  
individuals  with  dysphagia:  Australian  standardised  labels  and  definitions.  Nutr  Diet.  2007;64:53–76.  
 
Berzlanovich  AM,  Muhm  M,  Sim  E  et  al.  Foreign  body  asphyxiation—an  autopsy  study.  Am  J  Med  1999;107:  351–5.  
 
Centre  for  Disease  Control  and  Prevention.  Non-­‐fatal  choking  related  episodes  among  children,  United  States  
2001.  Morb  Mortal  Wkly  Rep.  2002;  51:  945–8.  
 
Chapin  MM,  Rochette  LM,  Abnnest  JL,  Haileyesus,  Connor  KA,  Smith  GA.  Nonfatal  choking  on  food  among  
children  14  years  or  younger  in  the  United  States,  2001-­‐2009,Pediatrics.  2013;  132:275-­‐281.  
 
Cichero  JAY,  Steele  CM,  Duivestein  J,  Clave  P,  Chen  J,  Kayashita  J,  Dantas  R,  Lecko  C,  Speyer  R,  Lam  P.  The  need  for  
international  terminology  and  definitions  for  texture  modified  foods  and  thickened  liquids  used  in  dysphagia  
management:  foundations  of  a  global  initiative.  Curr  Phys  Med  Rehabil  Rep.  2013;1:280–91.  
 
Dovey  TM,  Aldridge  VK,  Martin  CL.  Measuring  oral  sensitivity  in  clinical  practice  :  A  quick  and  reliable  behavioural  
method.  Dysphagia.  2013;  28:501-­‐510.  
 
Funami  T,  Ishihara  S,  Nakauma  M,  Kohyama  K,  Nishinari  K.  Texture  design  for  products  using  food  hydrocolloids.  
Food  Hydrocolloids.  2012;26:412–20.  
 
Garcia  JM,  Chambers  ET,  Matta  Z,  Clark  M.  Viscosity  measurementsof  nectar-­‐  and  honey-­‐thick  liquids:  product,  
liquid,  and  time  comparisons.  Dysphagia.  2005;20:325–35.  
 
Gisel  EG.  Effect  of  food  texture  on  the  development  of  chewing  of  children  between  six  months  and  two  years  of  
age.  Dev  Med  Child  Neurol.  1991;33:69–79.  
 
Hadde  EK,  Nicholson  TM,  Cichero  JAY.  Rheological  characterisation  of  thickened  fluids  under  different  
temperature,  pH  and  fat  contents.  Nutrition  &  Food  Science,  2015a;  45  (2):  270  –  285.  
 
Hadde  Ek,  Nicholson  TM,  Cichero  JAY.  Rheological  characterization  of  thickened  milk  components  (protein,  
lactose  and  minerals).  J  of  Food  Eng.  2015b;  166:263-­‐267.  
 
IASLT  &  Irish  Nutrition  and  Dietetic  Institute.  Irish  consistency  descriptors  for  modified  fluids  and  food.  2009.  
http://www.iaslt.ie/info/policy.php  Accessed  29  April  2011.  

ISO-­‐7886-­‐1:  1993  (E)  Sterile  hypodermic  syringes  for  single  use:  Part  1:  syringes  for  manual  use.  International  
Standards  Organisation  www.iso.org    
 
Japanese  Food  Safety  Commission,  Risk  Assessment  Report:  choking  accidents  caused  by  foods,  2010.  
 
Kennedy  B,  Ibrahim  JD,  Bugeja  L,  Ranson  D.  Causes  of  death  determined  in  medicolegal  investigations  in  residents  
of  nursing  homes:  A  systematic  review.  J  Am  Geriatr  Soc.  2014;  62:1513-­‐1526.  
 
Kutter  A,  Singh  JP,  Rauh  C  &  Delgado  A.  Improvement  of  the  prediction  of  mouthfeel  attributes  of  liquid  foods  by  
a  posthumus  funnel.  Journal  of  Texture  Studies,  2011,  41:  217-­‐227.  
 

The  IDDSI  Framework  and  Descriptors  are  licensed  under  the     12  

CreativeCommons  Attribution-­‐Sharealike  4.0  International  License    
https://creativecommons.org/licenses/by-­‐sa/4.0/  
October  10,  2016  
Morley  RE,  Ludemann  JP,  Moxham  JP  et  al.  Foreign  body  aspiration  in  infants  and  toddlers:  recent  trends  in  
British  Columbia.J  Otolaryngol  2004;  33:  37–41.  
 
Mu  L,  Ping  H,  Sun  D.  Inhalation  of  foreign  bodies  in  Chinese  children:  a  review  of  400  cases.  Laryngoscope  1991;  
101:  657–660.  
 
Murdan  S.  Transverse  fingernail  curvature  in  adults:  a  quantitative  evaluation  and  the  influence  of  gender,  age  
and  hand  size  and  dominance.  Int  J  Cosmet  Sci,  2011,  33:509-­‐513.  
 
National  Patient  Safety  Agency,  Royal  College  Speech  and  Language  Therapists,  British  Dietetic  Association,  National  Nurses  
Nutrition  Group,  Hospital  Caterers  Association.  Dysphagia  diet  food  texture  descriptions.2011.  http://www.ndr-­‐
uk.org/Generalnews/  dysphagia-­‐diet-­‐food-­‐texture-­‐descriptors.html,  Accessed  29  April  2011.  
 
O’Leary  M,  Hanson  B,  Smith  C.  Viscosity  and  non-­‐Newtonian  features  of  thickened  fluids  used  for  dysphagia  
therapy.  J  of  Food  Sci,  2010:  75(6):  E330-­‐E338.  
 
Peyron  MA,  Mishellany  A,  Woda  A.  Particle  size  distribution  of  food  boluses  after  mastication  of  six  natural  foods.  
J  Dent  Res,  2004;  83:578–582.  
 
Rimmell  F,  Thome  A,  Stool  S  et  al.  Characteristics  of  objects  that  cause  choking  in  children.  JAMA  1995;  274:  
1763–6.  
 
Seidel  JS,  Gausche-­‐Hill  M.  Lychee-­‐flavoured  gel  candies.  A  potentially  lethal  snack  for  infants  and  children.  Arch  
Pediatr  Adolesc  Med  2002;  156:  1120–22.  
 
Sopade  PA,  Halley  PJ,  Cichero  JAY,  Ward  LC.  2007.  Rheological  characterization  of  food  thickeners  marketed  in  
Australia  in  various  media  for  the  management  of  dysphagia.  I:  water  and  cordial.  J  Food  Eng  79:69–82.  
 
Sopade  PA,  Halley  PJ,  Cichero  JAY,  Ward  LC,  Liu  J,  Teo  KH.  2008a.  Rheological  characterization  of  food  thickeners  
marketed  in  Australia  in  various  media  for  the  management  of  dysphagia.  II.  Milk  as  a  dispersing  medium.  J  Food  
Eng  84(4):553–62.    
 
Sopade  PA,  Halley  PJ,  Cichero  JAY,  Ward  LC,  Liu  J,  Varliveli  S.  2008b.  Rheological  characterization  of  food  
thickeners  marketed  in  Australia  in  various  media  for  the  management  of  dysphagia.  III.  Fruit  juice  as  a  dispersing  
medium.  J  Food  Eng  86(4):604–15.  
 
Steele,  C,  Alsanei,  Ayanikalath  et  al.The  influence  of  food  texture  and  liquid  consistency  modification  on  
swallowing  physiology  and  function:  A  systematic  review.  Dysphagia.  2015;  30:  2-­‐26.  

Steele,  C.,  Molfenter,  S.,  Péladeau-­‐Pigeon,  M.,  Polacco,  R.  and  Yee,  C.  Variations  in  tongue-­‐palate  swallowing  
pressures  when  swallowing  xanthan  gum-­‐thickened  liquid.Dysphagia.2014;29:1-­‐7.  
 
Turkistani  A,  Abdullah  KM,  Delvi  B,  Al-­‐Mazroua  KA.  The  ‘best  fit’  endotracheal  tube  in  children.  MEJ  Anesth  2009,  
20:383-­‐387.  
 
Van  Vliet  T.  On  the  relation  between  texture  perception  and  fundamental  mechanical  parameters  of  liquids  and  
time  dependent  solids.  Food  Quality  and  Preference,  2002:  227-­‐236.  
 
Woda,  A,  Nicholas  E,  Mishellany-­‐Dutour  A,  Hennequin  M,  Mazille  MN,  Veyrune  JL,  Peyron  MA.  The  masticatory  
normative  indicator.    Journal  of  Dental  Research,  2010;  89(3):  281-­‐285.  

Wolach  B,  Raz  A,  Weinberg  J  et  al.  Aspirated  bodies  in  the  respiratory  tract  of  children:  eleven  years  experience  
with  127patients.  Int  J  Pediatr  Otorhinolaryngol  1994;  30:  1–10.  

The  IDDSI  Framework  and  Descriptors  are  licensed  under  the     13  

CreativeCommons  Attribution-­‐Sharealike  4.0  International  License    
https://creativecommons.org/licenses/by-­‐sa/4.0/  
October  10,  2016