Dysphagia and Texture modified foods: Why Cutting Food Smaller May Not Be Enough

“Could we just cut it into smaller pieces?”

It is a reasonable question when someone finds a meal difficult to manage. But cutting food changes its size. It does not necessarily change its hardness, tenderness, moisture or other texture characteristics.

For someone with dysphagia, preparing food means following their individual swallowing recommendations. The finished food then needs to be assessed using the relevant IDDSI testing methods.

Food preparation and food testing are different tasks

Cutting, mincing, mashing and blending are ways of preparing food.

IDDSI testing methods are used to assess the characteristics of the finished preparation and at time of serving.

These tasks are connected, but they are not interchangeable. Cutting a meal into smaller pieces does not confirm that it meets the intended IDDSI level.

Staff still need to assess the relevant characteristics after preparation.

A smaller piece can still be hard

Think about a raw carrot cut into small cubes.

The pieces are smaller, but cutting has not made the carrot soft. The same principle applies to a tough piece of meat. Chopping it into smaller portions does not necessarily change how easily it breaks down.

The preparation needs to address the characteristics required for the person’s recommended food level, rather than size alone.

Size requirements depend on the food level

Some IDDSI food levels specify particle size limits alongside other requirements.

For example, Level 6 Soft and Bite-Sized includes both size and softness requirements. Preparing food to the specified size addresses one requirement. Staff then need to assess whether it also meets the other criteria.

Food that is small enough but remains firm does not meet all the requirements. Food that is sufficiently soft but exceeds the specified piece size also needs attention. See examples of texture modified meals here.

Follow the relevant definition and IDDSI testing methods rather than relying on appearance.

Adding sauce does not automatically change the texture

A sauce may be part of preparing a suitable meal, but it does not automatically make firm food tender.

A tough piece of meat can remain tough beneath a layer of sauce. The finished combination may also have liquid separating from the food.

Preparation needs to address the specific characteristics of the ingredients and the intended food level.

After any modification, assess the finished food using the relevant IDDSI testing methods.

Mincing and blending also need follow-up testing

A mincer or blender can change food considerably, but the machine does not establish its IDDSI level.

A minced preparation may still contain firm particles. A blended preparation may contain lumps, be sticky or have separate liquid.

The question is whether the finished food meets the relevant criteria, not simply which equipment was used to prepare it.

Use an appropriate recipe or preparation process, then assess the result.

Use IDDSI testing methods after preparation

The relevant IDDSI testing methods depend on the intended level.

They assess characteristics such as softness, particle size and how the food behaves on a fork or spoon.

Staff need to follow the complete instructions and consider all the criteria that apply. One satisfactory result does not resolve a problem identified elsewhere.

Testing should take place under the intended serving conditions, particularly temperature. Official IDDSI testing methods

Keep the person’s recommendation in view

Assessing a prepared food and assessing a person’s swallowing are different tasks.

IDDSI testing methods help describe the food. They do not determine which level a person needs.

Staff should follow the person’s current swallowing recommendations or mealtime management plan. If a preparation does not meet the intended level, do not simply give it another label and serve it under the existing order.

Seek clarification through the appropriate care pathway.

What should happen when a meal needs further attention?

Describe the specific concern and follow the service’s process for resolving it.

For example, “the pieces remain firm when tested” gives the preparation team useful information. It identifies a texture concern rather than assuming that further chopping will solve it.

Further preparation or a replacement may be needed. The resulting food should be assessed before it is served as meeting the intended level.

Do not use the person’s response to eating an uncertain preparation as a way to decide whether it is suitable.

Help families understand the difference

Families may want to bring a favourite meal and ask whether cutting it finely would make it suitable.

Explain that size is one aspect of the preparation. Other food characteristics and the person’s recommendations also need consideration.

Invite them to discuss the dish with the appropriate team before offering it. Their knowledge of preferred flavours and familiar recipes can help that conversation.

The aim is to explore options without promising that one preparation step will make every food suitable.

Give staff practical opportunities to learn

Dysphagia education and training for aged care staff should clearly distinguish food preparation from IDDSI testing methods.

Workers need to understand how preparation can change food, how to assess the finished result and what to do when it does not meet the intended criteria.

Swallowing & Dysphagia Support provides IDDSI training for care and kitchen teams. Contact us to discuss training for your Sydney organisation and practical questions about preparing and testing texture-modified food.

This article provides general education. Follow the current official IDDSI definitions and testing methods, together with the person’s individual swallowing recommendations.