Diet Texture Modifications and Thickened Liquids

13 posts

IDDSI revised the framework March 2019 to include the Easy To Chew Level 7

IDDSI Bitsy Bites: Idaho Does IDDSI!

Conquer It In IDDSI Bitsy Bites! Sue Linja, RDN, LD, Owner, S&S Nutrition Network, Inc. When I was a little girl in small-town Idaho, we didn’t always have a lot to keep us busy. We often made up songs about people and their trials and tribulations, including this little ditty about my cousin, Mitzi.  While it didn’t go exactly like this, the rhyme has stuck in my head, so I thought I’d share it […]

picture of typical clear jello cubes made from gelatin, which is not the same as dysphagia training jelly.

Jelly & Jell-O Surprise: What’s Up With Jell-O, Jelly Cups, Dysphagia Training Jelly

Jelly & Jell-O Surprise: Jell-O, Jelly Cups, Dysphagia Training Jelly (Transitional Foods Blog Part 3 of 3) By Karen Sheffler, MS, CCC-SLP, BCS-S of with special contributions by Mari Kato-Nakao, MD, MA, (PhD candidate) on Japanese Dysphagia Training Jelly   Maybe you were just saying: “You had me at the Jell-O,” but I am not talking about Jell-O shots! You are tuning in for Part 3 of my three-part series on how Transitional Foods affect […]

Yield sign with safety first, used here to remind "patient safety first!"

Patient Safety First: Transitional Foods (Part 2)

Patient Safety First: Transitional Foods (Part 2) By Karen Sheffler, MS, CCC-SLP, BCS-S of Introduction Welcome back to Part 2 of my 3-part article on Transitional Foods (in the dysphagia diet framework on In Part 1 of this blog series, I addressed what transitional foods are, how to test them, ideas on their use in dysphagia treatment, and an example of a transitional food product. Next, it is important to address potential choking risks […]

Cotton Candy Therapy? Transitional Foods & Dysphagia Treatment

Cotton Candy Therapy? Transitional Foods as Potential Dysphagia Treatments By Karen Sheffler, MS, CCC-SLP, BCS-S of Got your attention with the cotton candy, didn’t I? Imagine wandering through your town’s summer festival sucking that sickly-sweet cotton candy until it magically disappears on your tongue. What other foods start out as a solid and then change or transition into a liquid or a paste with the warmth and moisture of your mouth? (You know the dentists […]

IDDSI revised the framework March 2019 to include the Easy To Chew Level 7

IDDSI Resources

INTERNATIONAL DYSPHAGIA DIET STANDARDISATION INITIATIVE (IDDSI) IDDSI_framework_with_creative_commons_Mar2019 IDDSI Resources complied by Karen Sheffler, MS, CCC-SLP, BCS-S of & IDDSI Champion Changing the world to this new dysphagia diet global standard will be no simple feat. However, it is crucial that we set goals for our facilities now, as the implementation kick-off was May 1, 2019 in the USA, per the American Speech-Language and Hearing Association and the Academy of Nutrition and Dietitics. The […]

FNCE: Food & Nutrition Conference & Expo by the Academy of Nutrition & Dietetics. This sign shows that the AND and FNCE are 100 years old! This blog is about SLPs learning to collaborate in dysphagia field with dietitians.

Collaboration in Dysphagia

ASHA + AND = Better Together: SLP & RD Collaboration in Dysphagia by Karen Sheffler, MS, CCC-SLP, BCS-S of “Are you going to /fɛnsi/?” (Yes, that was the international phonetic alphabet (IPA) to show SLPs how to pronounce FNCE. I am a Speech-Language Pathologist (SLP) who has specialized in swallowing and swallowing disorders (dysphagia) since 1995. I have collaborated with numerous dieticians across the continuum of care, and I did not know what “FNCE” was. […]

IDDSI: Interview with an Early Adopter of IDDSI Framework

IDDSI: Interview with an Early Adopter by Karen M. Sheffler, MS, CCC-SLP, BCS-S of Introduction I had the pleasure to speak with Kim Bradley, PhD, SLP reg.CASLPO, who is a speech-language pathologist (SLP) and manager at St. Michael’s Hospital in Toronto, Canada. Bradley is also an Assistant Professor in the Department of Speech Language Pathology at the University of Toronto. I asked her: Why was it so important for you and your healthcare facility be early implementors of this […]

Many people think that to not feed a person is to not give love. We need great recipes for people with dysphagia!

Recipes for People with Dysphagia: Don’t Forget Flavor

Recipes for People with Dysphagia compiled by Karen Sheffler, MS, CCC-SLP, BCS-S of Are you a foodie? Do you believe that food is love? Or do you just love to eat? Imagine if, due to difficulty swallowing (dysphagia), you could not eat your favorite foods. Imagine if everything was pureed and tasteless. Dysphagia diet modifications recommended by your speech-language pathologist (SLP) should not mean a loss of flavor and nutrition. SLPs and registered dietitians […]

Will the patient agree with your recommendations, taking the straight path? When we use patient-centered communication, we see that decision-making is more complex than a yes or no.

Decision-Making in Dysphagia Management

by Karen Sheffler, MS, CCC-SLP, BCS-S of Negative Press Detracts from Main Issue: Decision-Making in Dysphagia Background: When a person has difficulty swallowing (dysphagia) with high risks for aspiration of thin liquids, one of the most difficult decisions for a Speech-Language Pathologist (SLP) is whether or not the person would benefit from thickened liquids. SLPs who specialize in dysphagia, know that taking away thin liquids can drastically affect the person’s intake and quality of […]

Picture shows people around a globe working together for the common purpose of standardizing diets for patient safety.

“No Dysphagia Diet Modification without Standardization!”

Support Dysphagia Diet Standardization by Karen Sheffler, MS, CCC-SLP, BCS-S of Overview: On social media, in lectures and in blogs, I have been repeating: A global consensus on dysphagia diets, based on evidence, is coming soon. The International Dysphagia Diet Standarisation Initiative ( now asking us to “spread the word.” I think it is very appropriate that I write this blog in Boston, inspired by Boston’s revolutionary past. About 265 to 255 years ago (1750-1760’s) in […]

This picture shows pills/medication crushed and not crushed.

Hard Pill to Swallow?

Blog by Karen Sheffler, MS, CCC-SLP, BCS-S of Hard Pill to Swallow is a reference to a Bill Lupkin. Listen: Let’s imaging a patient with dysphagia compensating well with a soft, moist, easy-to-chew diet and thin liquids, following strategies including upright positioning and small sips. We think all is well in the patient’s world of eating and swallowing. Then, along comes medication time! Examples: Patient A knows she has to take her 30ml of […]

Remember our roots in the field of dysphagia, like Jeri A. Logemann.

Remember Our Roots: Jeri A. Logemann

Remember Our Roots: Jeri A. Logemann By Karen Sheffler, MS, CCC-SLP, BCS-S of Thank you Dysphagia Research Society for taking time at our annual meeting to reflect on our roots. We are honoring our mentor, Jeri A. Logemann, PhD, CCC-SLP, BCS-S. At the Dysphagia Research Society Annual Meeting in 2015, there were the following memorial tributes: Thursday, March 12, 2015 at 8:00am (following the 7:50am Opening Remarks by our board president: Kulwinder Dua, MD, […]