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Dysphagia and Feeding


Published: 17 September 2019

Cover image for article: Dysphagia and Feeding

Dysphagia is a common condition seen in many long-term care clients.

Although many factors can cause trouble swallowing, it is often seen in post-stroke clients and those who have dementia, where a person’s ability to control muscle movements in their throat and epiglottis has been affected (Health Direct 2018). This makes the person at risk of inhaling both food and liquids causing aspiration, which can lead to fatal pneumonia and choking.

When feeding a person with dysphagia, it is critical you know what types of food and at what consistency they are allowed to consume, therefore making it essential to consult a client’s care plan before feeding.

Liquid Consistency

Depending on a client’s swallow test (usually performed by a speech pathologist), the patient will be prescribed a particular consistency of liquid to match their ability.

Liquid consistency can be anywhere from puree-thick, to runny and thin.

Standards for Texture Modified Fluid Consistency

  • Level 0 - Thin
  • Level 1 - Slightly Thick
  • Level 2 - Mildly Thick
  • Level 3 - Moderately Thick
  • Level 4 - Extremely Thick

(IDDSI 2019)

Some of these fluids will come pre-prepared to the desired consistency, but others may need to have fluid thickener added to achieve the correct consistency for your client.

Food Consistency

Like liquids, foods should be served at a manageable consistency as well, depending on the ability of the client to chew or swallow.

Standards for Texture Modified Food Consistency

  • Level 3 - Liquidised
  • Level 4 - Pureed
  • Level 5 - Minced and Moist
  • Level 6 - Soft and Bite-Sized
  • Level 7 - Easy to chew / Regular

(IDDSI 2019)

(CC) The International Dysphagia Diet Standardisation Initiative 2016.

Some people will be on normal consistency foods and can eat anything that they choose, while others may be at the stage of consuming slightly thickened liquids in addition to normal consistency food.

The next step up is soft, bite-sized foods. This means that the food should not be crunchy, and the servings should be as manageable as possible. You should avoid raw vegetables and corn, and encourage moist and soft foods.

A further step into the consistency paradigm is minced and moist foods. This means that the consistency of the foods should be minced, bite-sized, and require as little chewing as possible to process in the mouth and swallow.

Smooth, pureed food is used for those who require the softest consistency, before moving to fully-liquidised nutrition. Everything must be the same texture and require no chewing.

Tips for Feeding

  • Clients may not enjoy eating softer foods. In these cases, try to vary foods on the menu.
  • Some studies show triggering different taste sensations, such as with sour or cold foods, can aid to stimulate the swallow reflex.
  • Be aware of ‘pouching’. This is when the client holds food in their cheek. Some patients can hold an entire meal in this way.
  • Another way to assist in swallowing is to have the patient tuck their chin to their chest. This can help with certain types of dysphagia and this method may be recommended by the client’s speech pathologist.
  • Some speech pathologists recommend stroking the side of a patient’s cheek to encourage them to swallow, but it depends on the cognitive level of your patient.
  • It is important to monitor your patient closely for signs of aspiration, such as coughing, gagging or turning red. This is a medical emergency and should be managed accordingly.
  • Dietary supplements may become necessary to ensure your client is receiving sufficient nutrition.

(Loret 2015; Pines of Sarasota 2016; IDDSI 2019)

Additional Resources

Multiple Choice Questions

Q1. True or False: The higher the level, the thicker the liquid consistency gets.

  1. True.
  2. False.

Q2. Pureed food is numbered at which level of food thickness?

  1. Level 0
  2. Level 1
  3. Level 2
  4. Level 3
  5. Level 4
  6. Level 5
  7. Level 6
  8. Level 7

(Answers: a, e.)


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Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date.

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Learner Reviews


12 Total Rating(s)

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Julie Wilson
16 Oct 2019

interesting - the resources were great

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jane taylor
03 Oct 2019

happy to learn

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Darinka Rozanic
02 Oct 2019

concise and helpful for all staff levels

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Sharda Mudaliar
01 Oct 2019

The topic was clear ,short and concise, very easy to understand

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Alarna Marie Young
28 Sep 2019

Excellent piece of reading to update knowledge already gained in the past.

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Christine munro
24 Sep 2019

It was good because it listed the levels of food from purée mince moist etc and the levels of thickness of fluids.

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Virginia Dixon
23 Sep 2019

Probably good for new nurses but I still learned something from it

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neenu aju antony
19 Sep 2019

i enjoyed

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Michelle McKay
26 Aug 2019

A quick an effective overview of the essential principles to maintain when feeding a patient with a swallowing difficulty

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Lisa Biddle
11 Aug 2019

Brief and concise and easy to read.