Living with Dysphagia

A person might have dysphagia (swallowing difficulty) if they show one or more of these signs, especially if they occur repeatedly or worsen over time:

During eating or drinking

• Coughing or choking while swallowing
• Gurgly, wet, or hoarse voice after swallowing
• Food or liquid leaking from the mouth
• Needing to swallow multiple times to clear one bite or sip
• Pain when swallowing (odynophagia)
• Feeling of food stuck in the throat or chest

After eating or drinking

• Frequent throat clearing
• Shortness of breath
• Unexplained weight loss or dehydration
• Recurring chest infections or pneumonia (from aspiration)

Observation clues

• Avoiding certain foods or textures
• Taking much longer than normal to finish meals
• Fatigue during eating
• Unusual facial expressions or grimacing while swallowing

If these signs are noticed, especially in elderly people, stroke survivors, or those with neurological conditions, a medical evaluation is needed.
Diagnosis is usually confirmed by a speech-language pathologist or doctor using tests such as a clinical swallow evaluation, videofluoroscopic swallow study (VFSS), or fiberoptic endoscopic evaluation of swallowing (FEES).

To know the thickness levels for dysphagia, you can follow the IDDSI (International Dysphagia Diet Standardisation Initiative) framework.
It classifies liquids from Level 0 (thin) to Level 4 (extremely thick) and uses simple tests to measure them. Read more here

Main Testing Method – IDDSI Flow Test

1. Use a 10 ml syringe (standard catheter-tip).
2. Block the nozzle with a finger and fill to exactly 10 ml.
3. Release finger and let liquid flow out for exactly 10 seconds.
4. Measure how much liquid is left in the syringe and compare to the table above.

Extra tip:
For home checks without a syringe, IDDSI also has the spoon tilt test (for Level 4 foods) and fork drip test (for thick liquids and purées). They’re not as precise but still help in a pinch.

If you’ve been diagnosed with dysphagia, what you need will depend on the type and severity of your swallowing difficulty, but most people benefit from a combination of:

Professional Support

• Speech-language pathologist (SLP) – designs a safe eating/drinking plan and teaches swallowing techniques.
• Dietitian – ensures you get enough calories, protein, and fluids despite texture changes.
• Doctor – treats underlying conditions (e.g., neurological, reflux, muscle weakness).

Safe Food & Drink Preparation

• Follow IDDSI texture levels for foods and liquids recommended by your SLP.
• Use thickening powders or pre-thickened drinks for liquids.
• Modify foods by blending, mashing, or chopping to the right texture.
• Avoid mixed textures (e.g., soup with chunks, cereal with milk) unless approved.

Adaptive Eating & Drinking Equipment

• Specialty cups (e.g., nosey cup, dysphagia cup, controlled slow flow cup).
• Special spoons (shallow bowl, soft edge).
• Non-slip placemats and plate guards if motor skills are affected.
• Straws only if approved by your SLP (can be risky for some).

Eating Environment & Habits

• Sit fully upright (90°) during and 30+ minutes after meals.
• Take small bites/sips and swallow before taking the next.
• Eliminate distractions so you can focus on swallowing.
• Eat slowly — fatigue can make swallowing less safe.

Emergency Awareness

• Know the signs of choking and aspiration.
• Caregivers should know Heimlich maneuver and when to call emergency services.

IDDSI stand for International Dysphagia Diet Standardisation Initiative.

It’s a global framework that standardizes terminology and definitions for texture-modified foods and thickened liquids to improve safety and consistency in caring for people with swallowing difficulties (dysphagia). It is categorized under a breakdown of the IDDSI levels (0–7). Read more here 

IDDSI levels are split into 2 groups: first is for liquids and the second is for food. Read more on how to test the levels at home

Liquids Level 0-4

• Level 0 – Thin
  Examples: water, coffee, tea, broth.
• Level 1 – Slightly Thick
  Examples: formula, breast milk, some pediatric thickeners.
• Level 2 – Mildly Thick (Nectar-like)
  Examples: nectar juices, smoothies, buttermilk.
• Level 3 – Moderately Thick (Honey-like)
  Examples: honey-thick drinks, thick milkshakes.
• Level 4 – Extremely Thick (Pudding-like)
  Examples: pudding, thick custard, pureed fruit.

Foods

• Level 3 – Liquidised
  Examples: blended soups, runny purees.
• Level 4 – Pureed
  Examples: mashed potato, smooth purees.
• Level 5 – Minced & Moist
  Examples: finely minced meats with sauce, mashed banana.
• Level 6 – Soft & Bite-Sized
  Examples: tender cooked vegetables, soft casseroles.
• Level 7 – Regular / Easy to Chew