• Diet modifications should consider the nutritional needs of the child to avoid undernutrition and malnutrition.

• Primarily serial assessment due to frequent changes in patient’s status day to day

• Trial with foods in current recommended consistency, attempt others as clinically appropriate

• If the patient is on a modified texture due to visualized aspiration on swallow study-particularly silent aspiration during a swallow study, repeat the swallow study before upgrading the diet

• Implement neuromuscular re-education program for patients with the cognitive ability to participate (Chin-tuck against resistance (CTAR), effortful swallow, tongue pull backs, Masako, Mendelsohn Maneuver, Shaker)

• Skilled education to patient AND caregivers (Aspiration precautions, compensatory strategies, exercises, plan of care)

• Consulting with the team, including a dietitian, is also a relevant consideration when altering a diet to ensure that the patient’s nutritional needs continue to be met. 

The International Dysphagia Diet Standardisation Initiative (IDDSI) was designed in consultation with clinicians and patients. IDDSI framework Is to be used by people who have feeding, chewing or swallowing deficits, caregivers, and clinicians.

IDDSI describes transitional foods as foods that start as one texture then change Into another texture when liquids such as water or saliva Is added or when there Is a temperature change. In this food texture level, minimal chewing Is required.

The evaluation of drinks and liquidized foods consists of a gravity Flow test using a 10ml syringe which Is used as an objective measure to classify drinks based on their rate of flow. The IDDSI Flow test Is sensitive enough to Identify small changes In thickness combined with changes In serving temperature. 

Testing methods for purees, soft, firm, and solid foods Include: The Fork Drip test, Spoon Tilt test, Fork or Spoon Pressure Test, Chopstick Test, and Finger Test. A combination of these tests may be necessary to Identify which level a food fits Into.

Speech-Language pathologists are not quick to to recommend a patient on an altered diet or thickened liquids. SLPs must look at the following options such as pacing, postural/position techniques, and maneuvers. 

SLPs must consider the patient’s cognitive ability to use these different options. If a person is unable to cognitively utilize these options, the SLP will then move forward in their evaluation and trial thickened liquids or an altered diet. 

SLPs must keep in mind that if an altered diet consistency or thickened liquid is recommended, it is to make eating/drinking more comfortable and safer for the patient and eliminate the deficits seen during the swallowing evaluation.