Level 1 – Pureed (Most impaired)
- For individuals with moderate to severe swallowing difficulty.
- Poor jaw or tongue control, and delayed swallow.
- Pureed allows extra time for the swallow response to trigger.
- No course textures are allowed.
- No mastication is allowed.
- Advance to next level as soon as possible.
- Examples: pudding, pureed foods, hummus.
Level 2 – Mechanical Soft
- For individuals with mild to moderate swallowing difficulties.
- Some rotary chewing with tongue control, but a minimally delayed swallow.
- Examples: scrambled eggs, meatloaf, well-cooked vegetables, pancakes, mashed potatoes, canned/cooked soft fruits.
Level 3 – Advanced
- For individuals able to chew with adequate oral motor skills.
- 1 step down from a regular diet.
- Examples: bread slices, muffins, moistened cereals, pasta, baked potatoes, soft/ripe fruits, fish.
Level 4 (Regular)
- Includes all foods.
Spoon-thick (Most impaired)
- Commercial thickener
- Nectar thickened with banana, nectar thickened with pureed fruit, regular applesauce with juice, eggnog with baby cereal, creamed soap with mashed potatoes, commercial thickener.
- Examples: nectars, extra-thick milkshake, extra-thick eggnog, strained creamed soups, yogurt and milk blended, V-8 juice.
- Examples: water, coffee, tea, milk, hot chocolate, fruit juices, broth, gelatin dessert, ice cream, sherbet.