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Why should I transition to using IDDSI with my patients?

Jennifer Raminick, MA, CCC-SLP, BCS-S, Danielle Ward, MA, CCC-SLP

December 15, 2023



Why should I transition to using IDDSI with my patients?


IDDSI was created in 2013 to provide more consistent terminology and easily accessible testing methods. The world first heard about IDDSI in 2015 when it was published, providing clear guidelines for testing methods and texture modification of foods and liquids. The goal was to create globally standardized terminology and descriptions for diet modification across all ages, care settings, and cultures, providing clear consistency guidelines and simple carry-over with easily accessible testing tools. The National Dysphagia Diet (NDD) does not have easily accessible testing methods and results in ambiguity about what consistency you are providing your patients. With IDDSI, you can test any food or liquid in 10 seconds or less using items most individuals have on hand in their kitchens.

While there is no mandatory rule that you MUST implement IDDSI, it is strongly recommended and has also been endorsed by ASHA. It is becoming best practice to use IDDSI terminology in your assessment and treatment. Additionally, across disciplines, IDDSI is becoming widely used. The Academy of Nutrition and Dietetics announced in October 2021 that IDDSI will be used by the Nutrition Care Manual (NCM) as the only recognized texture-modified diet, and the NDD will no longer be used. Consumer products are also becoming labeled using IDDSI terminology and color schemes. Our patients and providers are becoming more comfortable with using IDDSI, and as such, we should be too. While the implementation process can seem overwhelming, actually using IDDSI in your practice is very easy. Additionally, knowing you are providing and teaching families diet modification that is accurate and reproducible is worth it.

This Ask the Expert is an excerpt from the course, 20Q: In the Thick of It - The International Dysphagia Diet Standardization Initiative (IDDSI), by Jennifer Raminick, MA, CCC-SLP, BCS-S and Danielle Ward, MS, CCC-SLP.

jennifer raminick

Jennifer Raminick, MA, CCC-SLP, BCS-S

Jen Raminick graduated from California State University, Long Beach and has been a speech-language pathologist at CHOC Children’s for 8+ years. She has earned her Board-Certified Specialist accreditation in Swallowing and has multiple leadership roles in the hospital, including a chair of the Clinical Practice Committee to guide patient care.  She has mentored graduate students and fellow therapists, with an emphasis on MBSS and acute inpatient competency.  At CHOC, she has led a committee to implement the International Dysphagia Diet Standardization Initiative, providing guidance and education to multiple departments throughout the hospital.  She has also worked on a team to write a grant for Fiberoptic Endoscopic Evaluation of Swallowing equipment and is working to develop a comprehensive FEES program.  She has been both a national and regional speaker, presenting at the California and American Speech-Language-Hearing Association’s annual conventions covering topics such as feeding on High Flow Nasal Cannula and implementing the IDDSI.

danielle ward

Danielle Ward, MA, CCC-SLP

Danielle graduated from California State University, Long Beach and has been a pediatric speech-language pathologist for over six years. She has spent most of her career working at a pediatric acute care hospital where she has experience working with infants and children with a variety of feeding, swallowing, and communication disorders. Danielle has experience as a member of the clinical practice council to promote quality patient care and has been a clinical instructor and mentor to graduate students and guest lecturer to undergraduate students. Danielle has presented both regionally and nationally on topics such as curriculum-based language intervention, word-retrieval in individuals with aphasia, and the International Dysphagia Diet Standardization Initiative (IDDSI). Danielle co-led her hospital in the implementation of the newly established IDDSI. Under Danielle’s guidance, her hospital was proud to be one of the pioneer children’s hospitals to successfully implement the IDDSI framework.

Related Courses

20Q: In the Thick of It - The International Dysphagia Diet Standardization Initiative (IDDSI)
Presented by Jennifer Raminick, MA, CCC-SLP, BCS-S, Danielle Ward, MA, CCC-SLP


Jennifer Raminick, MA, CCC-SLP, BCS-SDanielle Ward, MA, CCC-SLP
Course: #10756Level: Intermediate1 Hour
  'Fascinating course! So fortunate to have all the information regarding standardization of diets'   Read Reviews
The importance of using IDSSI to provide standardized language when speaking about texture modification is discussed in this course. Comparisons of IDDSI and the National Dysphagia Diet (NDD), as well as IDDSI standards for pediatric vs. adult patients are presented. Additionally, potential barriers, solutions, and frequently asked questions related to implementation of IDDSI are described.

20Q: Beyond the Swallow - Tracheostomy Tube and Ventilator Management
Presented by George Barnes, MS, CCC-SLP


George Barnes, MS, CCC-SLP
Course: #10056Level: Intermediate1 Hour
  'It was a great summary and overview for adult consideration'   Read Reviews
This course addresses the various questions that may arise for the medical SLP involved in the care of patients with tracheostomy and/or mechanical ventilation. Topics include causes of respiratory failure, consequences of tracheostomy/ventilation, risk management related to intervention, and considerations for assessment and treatment of swallowing and communication, including the use of speaking valves.

20Q: Head and Neck Cancer for the Speech-Language Pathologist
Presented by Barbara Messing, PhD, CCC-SLP, BCS-S, FASHA


Barbara Messing, PhD, CCC-SLP, BCS-S, FASHA
Course: #10591Level: Advanced1 Hour
  'Good to keep up with advanced HNC research!'   Read Reviews
Aspects of head and neck cancer (HNC) management relevant to the speech-language pathologist considering working with this population are described in this course. Specifically, HNC diagnosis and treatment, surgical and reconstructive options, communication and swallowing issues, treatment-related toxicities, and the impact on quality of life are addressed.

Overview of Flexible/Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Presented by Molly Sloan, MA, CCC-SLP


Molly Sloan, MA, CCC-SLP
Course: #10850Level: Introductory1.5 Hours
  'Presenter's experience and knowledge'   Read Reviews
This course provides the SLP with resources to prove the medical necessity for swallow instrumentation. An overview of the FEES procedure based on medical literature is provided, including labeling anatomy, describing swallow function as viewed on FEES, and outlining the benefits/limitations of FEES. Examples of when FEES may be the ideal choice of instrumentation are also discussed.

20Q: Evaluation and Management of Pediatric Dysphagia
Presented by Claire Kane Miller, PhD, CCC-SLP, BCS-S


Claire Kane Miller, PhD, CCC-SLP, BCS-S
Course: #9061Level: Intermediate1 Hour
  'I like the content'   Read Reviews
This course provides an overview of pediatric dysphagia, with a specific focus on the role of the speech-language pathologist in the assessment and treatment of infants and children with dysphagia. Clinical protocols for clinical and instrumental assessments are reviewed and options for treatment interventions are summarized.

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