If your family member has been told they need a “modified diet” or has been given an IDDSI level number by their speech therapist, you may feel uncertain about what this means in practice. This guide explains the IDDSI system in everyday language — no clinical jargon — and gives you practical guidance on shopping, cooking, and safe meal times in a Hong Kong household.
IDDSI stands for the International Dysphagia Diet Standardisation Initiative. It is a system created by healthcare experts from around the world to ensure that when a doctor or therapist says your family member needs a specific type of food or drink, everyone — hospital kitchen, home carer, care home cook, family member — means and prepares the exact same thing.
Before IDDSI, a “soft diet” at one hospital might be very different from a “soft diet” at another. This inconsistency caused accidents, including people choking on food that was supposed to be safe for them. IDDSI solves this by giving every food texture and drink thickness a number from 0 to 7, with clear physical tests to check that the food is prepared correctly.
Drinks (Levels 0–4):
Foods (Levels 3–7):
When your family member is discharged from hospital, the speech therapist will give you a diet prescription. It typically says something like:
Food: IDDSI Level 5 Minced and Moist Drinks: IDDSI Level 2 Mildly Thick
This means:
Both parts apply every time your family member eats or drinks. Not just when they seem to be struggling — every meal, every day.
For Level 4 and 5 meals, buy regularly:
For Level 6 meals, also buy:
Thickener for drinks:
Keep everything moist. Dry food is dangerous. Add broth, gravy, or sauce to every dish. If the food looks dry after cooking, add more moisture before serving.
Cook everything longer than you normally would. For Level 5 and 6, vegetables and meat need to be significantly more cooked than for a regular family meal. Taste and press with a finger — it should yield easily.
Use a food chopper or small food processor. For Level 5, it is difficult to mince food finely enough by hand for every meal. A small electric food chopper (available from supermarkets for under HK$200) saves time and produces more consistent results.
Serve food immediately. Food cools quickly and thickened drinks can continue to thicken over time, especially if a starch-based thickener is used. Prepare and serve promptly.
Don’t mix textures on the same plate. It is tempting to serve a normal meal with one separate modified component, but food textures often mix on the plate — a piece of tofu contaminated with a hard noodle piece can cause choking. Keep the whole meal at the same IDDSI level.
Always sit upright. Your family member must be seated with their back upright (as close to 90 degrees as possible) for all meals and for at least 30 minutes after eating. Do not feed anyone lying down or tilted in bed.
No distractions. Turn off the television, put away the phone. Eating safely requires concentration, especially for someone with dysphagia.
Small amounts, slowly. Offer small spoonfuls and wait for a complete swallow before the next. Do not rush. A meal may take 30–45 minutes.
Watch for warning signs during the meal:
If any of these happen consistently, stop the meal and contact the speech therapy department.
You should contact the speech therapy outpatient clinic or the referring hospital SLT department if:
Do not wait until the next scheduled clinic appointment if you are concerned. A brief phone call can often resolve uncertainty quickly — or trigger a timely review that prevents a serious complication.