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
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.
Level 4 answers and recipes
Is applesauce IDDSI Level 4?Smooth applesauce usually behaves like IDDSI Level 4 (Extremely Thick / Pureed), but it varies by brand and even by cup. Watery liquid often separates near the end of a container. Always check with the spoon tilt test before serving, and avoid “chunky” or “homestyle” varieties entirely.Is yogurt IDDSI Level 4?Plain, smooth, whole-milk yogurt with no fruit pieces or mix-ins typically tests at IDDSI Level 4, but thinner yogurts can test at Level 3, and any yogurt with inclusions fails Level 4 outright. Verify each brand with the spoon tilt test.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.Pureed Chicken with Gravy30 min · serves 1 + the family · ends with the Level 4 check.Pureed Macaroni & Cheese25 min · serves 2 · ends with the Level 4 check.Sunday Roast Chicken Dinner35 min · serves 1 + the family · ends with the Level 4 check.Hearty Beef Stew Dinner40 min (after the stew) · serves 1 + the family · ends with the Level 4 check.