Common questions

What IDDSI level is pureed food?

Pureed food is IDDSI Level 4. The number covers two names: drinks at Level 4 are called Extremely Thick, foods at Level 4 are called Pureed. Level 4 food is smooth with no lumps, holds its shape on a spoon, is not sticky, and must pass both the fork drip test and the spoon tilt test.

IDDSI numbers the level, not the name, which is why the same green “4” appears on a handout headed Extremely Thick and on one headed Pureed. If a chart, menu, or discharge summary says “Level 4” for food, it means pureed.

The official descriptors are specific: pureed food is usually eaten with a spoon, does not require chewing, has a smooth texture with no lumps, holds its shape on a spoon, falls off in a single spoonful when tilted, is not sticky, and does not let liquid separate out from the solids.

Not sticky matters as much as smooth. IDDSI singles out stickiness because pureed food that clings can stay behind on the cheeks, teeth, roof of the mouth, or in the throat after the swallow.

Pureed food must pass both tests, not either one. On the fork drip test it sits in a mound above the prongs and may form a small tail underneath, but it must not dollop or drip continuously through them. On the spoon tilt test it holds its shape, then slides off fairly easily when the spoon is tilted or lightly flicked.

Your speech-language pathologist decides whether Level 4 is the right texture. This page only explains what the number means so you can read a chart or a product label correctly.