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Writer's pictureSophia Apgar

Making Holiday Meals Accessible for All: A Guide to IDDSI Level 4-6 Dysphagia Diets

The holidays are a special time when families gather around the table to share a meal, create memories, and celebrate traditions. But what happens when someone in your family has specific dietary needs or challenges with swallowing? It can be a difficult situation to navigate, especially when everyone else is enjoying a spread of delicious foods, but there’s good news: you can still enjoy the festive feast while ensuring that everyone, regardless of their swallowing abilities, can join in!


Table of thanksgiving foods

This year, we decided to modify our holiday meal to meet IDDSI Levels 4-6, creating a meal that is both safe and delicious for everyone at the table. Whether you're preparing for someone with dysphagia (swallowing difficulties) or simply want to ensure your meal accommodates all types of eaters, adapting textures doesn’t have to mean sacrificing taste or tradition.


What is IDDSI?

Before diving into how we adapted our holiday meal, let’s quickly review what IDDSI stands for. The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a globally recognized framework for classifying food and drink textures for individuals with swallowing difficulties. The goal is to standardize food preparation so that those with dysphagia can enjoy meals safely and comfortably.

The IDDSI framework uses levels from 0 to 7, with each level representing a different food texture:

  • Level 0: Thin liquids

  • Level 1: Slightly thicker liquids

  • Level 2: Mildly thick liquids

  • Level 3: Liquidized foods

  • Level 4: Pureed foods

  • Level 5: Minced and moist foods

  • Level 6: Soft and bite-sized foods

  • Level 7: Regular foods

For our holiday meal, we focused on Levels 4-6, ensuring that we could cater to individuals with varying swallowing needs. Here’s how we modified the classic holiday dishes to make sure everyone could participate in the celebration, no matter their dietary requirements.


Adapting Holiday Dishes for IDDSI Levels 4-6

Level 4: Pureed

For those who require Level 4 textures, we aimed for smooth, velvety dishes that are easy

to swallow without chewing. Classic mashed potatoes with turkey gravy a naturally pureed.

How we modified:

  • Turkey:Puree your cooled turkey with some stock and gravy until smooth

  • Mashed potatoes: Pureed with a touch of butter and cream for a silky consistency.

  • Gravy: Blended into the mashed potatoes to ensure it was smooth and cohesive.

  • Cranberry Sauce: If cooked until smooth, this is already an IDDSI level 4. Otherwise, blend a textured cranberry sauce until smooth.

  • Pumpkin Pie: Pie filling is pureed so remove the crust and add some whipped cream, you're ready to enjoy!

Level 5: Minced & Moist

For Level 5, we focused on creating foods that are moist and finely minced so they are easy to chew and swallow. The key is to keep the textures soft and moist without being too dry or tough. All food should be chopped to 4mm pieces

How we modified:

  • Turkey: Chop turkey into 4mm pieces and top with some gravy for more moisture.

  • Stuffing: Softened and minced, then moistened with turkey gravy to create a cohesive, easily manageable texture.

  • Mashed potatoes and Cranberry Sauce: For IDDSI level 5, no modification is needed.

  • Pumpkin Pie: Remove crust for safety!



Level 6: Soft & Bite-Sized

For individuals who can manage soft, bite-sized pieces but still need help with chewing, Level 6 foods were the way to go. Dishes like stuffing and mashed squash should be cut into small, tender pieces that can be chewed easily, with no hard edges or tough skins.

How we modified:

  • Turkey: Cook the turkey until very tender, then cut or finely mince it into bite-sized pieces no larger than 1.5cm x 1.5cm (½ inch). Add some gravy for more moisture.

  • Stuffing: Softened to be easy to bite into, cut into small cubes for easy chewing.

  • Mashed potatoes and Cranberry Sauce: No modification is needed.

  • Pumpkin Pie: Again, remove crust for safety!




The Key to Inclusive Holiday Meals

Adapting a holiday meal to meet IDDSI Levels 4-6 does not require making anything bland or boring. It’s about preserving the flavors and textures that make holiday meals special, while ensuring the meal is safe and accessible for everyone at the table.  You can use all your holiday foods that you are already making and blend or chop to the right texture and size. With the right modifications, dishes like mashed potatoes, stuffing, turkey, and vegetables can be enjoyed by anyone, no matter their swallowing abilities.


By making these small but thoughtful adjustments, we can create an environment where everyone feels included, no one is left out, and the holiday spirit is alive and well in every bite.


Remember: Always Consult a Healthcare Professional

While we’re excited to share these tips and modifications, it’s important to remember that dietary needs are highly individual. The information provided here is for educational purposes only and should not be used as a substitute for medical advice. Always consult with a healthcare professional or a registered dietitian to ensure your meal modifications are safe and suitable for the person you’re cooking for.


Conclusion

This holiday season, make it a point to celebrate togetherness by making sure your holiday meal is accessible for everyone, regardless of their dietary needs. Whether you’re cooking for someone who requires pureed food, minced textures, or soft, bite-sized pieces, a little preparation can go a long way in making your feast a memorable and inclusive experience. After all, everyone deserves to enjoy the flavors of the season!


This post is for educational purposes and is not intended as medical advice. Always consult with a healthcare professional for personalized recommendations.

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