IDDSI Level 4
Extremely Thick / Pureed
Eaten with a spoon. Holds its shape. No chewing needed.
What it is
Smooth, cohesive purée with no lumps. Cannot be drunk from a cup; usually eaten with a spoon. No chewing required — the tongue alone can manage it.
What it looks like
Sits in a mound on the plate or spoon with a small peak. No liquid separating out.
The official test
video: Level 4 testing method
Fork drip test: sits in a mound on the fork; a small tail may form below the prongs but it does not drip continuously. Spoon tilt test: holds shape on the spoon, slides off in one piece when tilted, leaving little residue.
Run the guided fork & spoon testsFoods that typically fit
- Smooth puréed meats, vegetables, fruits
- Thick-style smooth yogurts (no fruit pieces)
- Commercial Level 4 purée meals
- Smooth mashed potatoes with extra moisture, sieved
Products can vary by batch. Always verify with the IDDSI tests before serving.How to test →
Common mistakes
- Watery purées that separate — liquid weeping out can be aspirated like a thin liquid.
- “Just a little” bread soaked in soup — mixed consistencies are the most common Level 4 error.
- Lumpy mash — Level 4 must pass through a sieve.