As the temperature drops and frosty mornings begin, on comes the heaters, hot foods and drinks, and nights rugged up in blankets. Throughout the colder months, evenings are filled with bowls of warm sweet treats such as brownies, apple crumble or sticky date pudding often paired with a generous scoop of ice cream. Although a beloved treat enjoyed by many, for those with dysphagia, a condition that affects swallowing ability. Ice cream may seem like a harmless ‘melt in your mouth’ treat, but it can pose choking and/or aspirating risks.
Whilst delicious and refreshing, ice cream’s texture and temperature can pose risks for individuals with dysphagia if not managed properly. For individuals with dysphagia, working with or caring for people with dysphagia, it is important to understand IDDSI guidelines and the crucial role speech pathologists play in promoting safe and enjoyable ice cream consumption.
The International Dysphagia Diet Standardisation Initiative (IDDSI) categorises food based on their texture and consistency to ensure safety for individuals with swallowing difficulties. Under the IDDSI framework, ice cream is classified as a ‘Transitional Food’, meaning that it is a food that changes from one texture into another when there is a temperature change or saliva added.
Understanding how ice cream can pose a choking risk under the IDDSI framework is crucial for those at risk of aspiration/choking.
Understanding Dysphagia and Choking risks
Dysphagia encompasses a range of swallowing difficulties that can arise from various medical conditions such as stroke, Parkinson’s disease, or head and neck cancers. These challenges can affect the ability to chew, move food through the mouth and down the throat, and the ability to safely swallow without the risk of choking and/or aspiration (food or drink entering the airway).
Why is Ice Cream a risk for people with dysphagia?
For individuals with dysphagia, ice cream presents with specific risks due to:
Texture and consistency: Whilst ice cream is generally smooth and creamy, its consistency can vary widely. Soft ice cream, for example tends to be more aerated and can melt quickly into a thin liquid which can pose choking and/or aspiration risks for individuals on a modified diet, or with swallowing disorders.
Temperature: The cold temperature of ice cream can affect oral sensitivity and muscle coordination required for safe swallowing.
Individual factors: People with dysphagia may have difficulty managing certain textures or coordinating swallowing movements. Changes in texture, such as hard frozen chunks or sticky ice cream toppings, can be difficult to safely swallow.
IDDSI and Transitional foods such as Ice Cream
The IDDSI framework are guidelines that categorise modified food textures into levels ranging from 3 to 7, with 3 representing liquidised foods and 7 representing regular solid foods. This classification helps healthcare professionals and caregivers choose appropriate foods that match an individual’s swallowing abilities.
When you eat ice cream straight from the freezer, it often goes into your mouth as a soft solid that melts into a liquid in your mouth due to the temperature change. This is an example of a transitional food.
Under IDDSI guidelines, ice cream is classified as a ‘Transitional Food’ however, many often incorrectly classify ice cream’s texture level (e.g. classifying it as a Level 4: Puree) and may assume it is safe for consumption for individuals on a Level 4 Puree diet.
Generally, on a Level 4 – Puree Diet, ice-cream is not recommended according to the IDDSI guidelines. This is because ice cream and other transitional foods can be a choking and/or aspiration risk for someone with dysphagia, if not appropriately managed.
Individuals with dysphagia may find it more difficult to manage the change in textures and coordinate a safe swallow, and the changed texture of the ice-cream may prematurely go down the throat to be swallowed without the individual being ready.
The good news is that no-melt ice-cream can be purchased and would be suitable for an individual on a Level 4 – Puree Diet to consume.
Some other examples of transitional foods include:
Chocolate
Wafers
Cheeto puffs
Rice puff
Ice
Jelly
Watermelon
Thickened liquids and Ice Cream
Unfortunately, for those on thickened liquids, ice-cream is off the menu. As ice-cream melts into what would be classified as a thin liquid, it would not be safe for someone recommended thickened fluids to consume.
Read more about Thicken Fluids here.
Role of Speech Pathologists in managing swallow disorders
Speech pathologists play a critical role in assessing and managing swallow disorders, including ways to manage the consumption of transitional foods, like ice cream. A speech pathologists’ involvement can help to reduce risks of choking and improve safety during mealtime.
Assessment and diagnosis of dysphagia
Speech pathologists conduct assessments to diagnose the nature and severity of dysphagia. This includes assessing oral motor function, swallow function and determining any risks associated with different food textures.
Treatment and management of dysphagia
Based on assessment findings, speech pathologists may recommend modifying textures of food and/or fluids for safe swallowing. This may include modifying transitional foods, like ice cream, to meet IDDSI guidelines and ensure it can be safely consumed without risk of aspiration. Depending on the individual, speech pathologists may recommend exercises to improve swallow function, strengthen muscles involved in swallowing, and enhance swallow coordination.
Education and training
Speech pathologists educate individuals with dysphagia, their caregivers, and healthcare teams about the IDDSI framework and diet modifications, safe swallowing techniques, proper posture during meals, and strategies for managing dysphagia-related challenges.
Find out more about our IDDSI Training on offer.
Collaborating with healthcare team
Speech pathologists work closely with physicians, nurses, dietitians, and other healthcare professionals to develop comprehensive dysphagia management plans that address nutritional needs and overall health.
Enhancing quality of life
Speech pathologists consider each person’s preferences, dietary habits, and cultural considerations when recommending modified diets and support swallow safety and enjoyable eating experiences.
Ice Cream: A Treat with Risks
Whilst ice cream seems like a soft, creamy and easy to eat treat, it is important to be mindful of the choking and/or aspiration risks of ice cream and other transition foods for people with dysphagia. The IDDSI framework provides valuable guidance in categorising food textures to ensure safe food consumption and support individuals to enjoy ice cream safely.
Navigating ice cream consumption for individuals with dysphagia requires careful consideration of texture modifications and adherence to IDDSI guidelines, guided by speech pathologists and other health professionals. Through specialised knowledge, speech pathologists play a pivotal role in promoting safety, dignity, and the pleasure of enjoying ice cream for individuals living with swallowing difficulties.
If you need a Speech Pathologist, our team of speechies are here to help.