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Stroke: Tips for Swallowing

Your speech therapist will put you on a special diet to help make swallowing safer and easier. Your diet will change as your swallowing improves. As a general rule, chew thoroughly and don't rush when you eat. This will lower your risk for aspiration pneumonia. This can occur if food or liquid gets into your lungs and can be very serious. Follow the swallowing guide below. Your speech therapist will check off the boxes that apply to you.

Which side of mouth to use:

☐ Left

☐ Right

Guide for swallowing




☐ None

☐ Puréed

☐ Soft

☐ Regular

☐ Other _________________

☐ None by mouth

☐ Ultra thick

☐ Thick

☐ Thin

☐ Other _________________

☐ None by mouth

☐ Crushed tablet

☐ Liquid form only

☐ With food

☐ With water

☐ Other _________________

Body posture


☐ Sit up straight (90 degrees)

☐ Recline ______ degrees

☐ Face forward

☐ Remain upright ______ minutes after a meal

☐ Other _________________

☐ Turn head left/right

☐ Tuck chin for each swallow

☐ Tuck chin for ___________

☐ 2 swallows/double swallow

☐ Alternate liquids and solids

☐ Other _________________

Levels of dysphagia diet

The International Dysphagia Diet Standardization Initiative (IDDSI) has created a diet plan or framework for people with dysphagia. The dysphagia diet has levels that rate drinks and foods on a thickness scale from 0 to 7. Drinks are ranked from 0 to 4. Foods are ranked from 3 to 7, depending on thickness. The levels are:

Liquid levels

  • Level 0 (thin). These are watery liquids, such as juice, tea, milk, soda, beer, and broth. You can drink them through a nipple, cup, or straw.

  • Level 1 (slightly thick). These are thicker than water. They need more effort to drink than thinner liquids but still flow through a straw or nipple.

  • Level 2 (mildly thick). These liquids flow off a spoon but more slowly than thinner drinks. They can be sipped or sucked from a straw with some effort.

  • Level 3 (liquidized, moderately thick). You can drink these from a cup or sucked from a straw with some effort. These are liquids that may be thick enough to be eaten with a spoon. An example is a thick milkshake. Their texture is smooth without lumps.

  • Level 4 (pureed, extremely thick). These are usually eaten with a spoon. You can't drink them from a cup. An example is pudding.

Food levels

  • Level 3 (moderately thick). These are foods that:

    • Don't require chewing

    • Have a smooth texture but are not lumpy

    • Can be eaten with a spoon, but not with a fork

    • Are not thick enough to stand stiff on a plate. For example, not stiff like molded gelatin.

  • Level 4 (pureed, extremely thick). These foods:

    • Can often be eaten with a spoon, but sometimes a fork

    • Can't be drunk from a cup

    • Don't need to be chewed

    • Can be molded, such as gelatin

    • Are not sticky or lumpy

    • Fall off a spoon all together when tilted and still hold shape on a plate. For example, pudding.

    • Can't be poured but move very slowly if the plate is tilted

  • Level 5 (minced, moist). These foods:

    • Can be eaten with a fork or spoon, or a chopstick if you have good hand control

    • Can be scooped and shaped on a plate. For example, mashed potatoes.

    • Are soft and moist but don't separate into liquid

    • May have small lumps that can be mashed with the tongue

  • Level 6 (soft). These foods:

    • Are tender, moist, and bite-sized

    • Can be eaten with a fork, spoon, or chopsticks but don't need a knife to cut

    • Must be chewed

  • Level 7 (regular). These are:

    • Normal, everyday foods of varying textures, including soft, stringy, and hard and crunchy

    • Foods that can be eaten by any method. For example, from a cup or using utensils.

    • Foods that need to be chewed, with all types of textures and may have pieces that can't be swallowed, such as gristle

Online Medical Reviewer: Anne Fetterman RN BSN
Online Medical Reviewer: Deepak Sudheendra MD
Online Medical Reviewer: Raymond Kent Turley BSN MSN RN
Date Last Reviewed: 12/1/2022
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