MIU IV Feeding and Swallowing by Amy Miller

Level 7 (Regular)

amymillermiuiv — 2025-01-06 15:37:16 UTC

No food modifcations or restrictions.

Level 7EC (Regular, Easy to Chew)

amymillermiuiv — 2025-01-06 15:47:45 UTC

Must be able to break food apart with the side of utensil. Thumbnail blanches white when pressed down with fork and food does not regain shape.

Level 6 (Soft and Bite-sized)

amymillermiuiv — 2025-01-06 15:55:43 UTC

Pre-cut food into bite-sized pieces. Thumbnail blanches white when pressed down with fork, food squashes down completely and does not regain shape.

Level 5 (Minced and Moist)

amymillermiuiv — 2025-01-06 16:00:56 UTC

Food should be fork mashed (lumps can fit through fork prongs) and not firm or sticky. Holds its form when held on utensil and falls off fairly easily if tilted or flicked.

Level 4 (Pureed)

amymillermiuiv — 2025-01-06 16:05:18 UTC

Does not require chewing and should not be too sticky. Liquid does not dollop or drip continuously through fork prongs (may form a tail), holds its form on spoon and falls off fairly easily if tilted or flicked.

Level 0 (Thin)

amymillermiuiv — 2025-01-06 16:07:52 UTC

No modifications, flows like water.

Level 1 (Slightly Thick)

amymillermiuiv — 2025-01-06 16:10:21 UTC

Natural nectar, 1-4mL remaining in syringe after 10 seconds of flow.

Level 2 (Mildly Thick)

amymillermiuiv — 2025-01-06 16:12:27 UTC

Nectar-thick, 4-8mL remaining in syringe after 10 seconds of flow.

Level 3 (Moderately Thick)

amymillermiuiv — 2025-01-06 16:15:36 UTC

Honey-thick, no less than 8 mL remaining in the syringe after 10 seconds of flow.

Level 4 (Extremely Thick)

amymillermiuiv — 2025-01-06 16:21:06 UTC

Pudding/puree, does not require chewing and should not be sticky. Liquid does not dollop or drip continuously through fork prongs (may form a tail), holds its form on spoon and fall off fairly easily if tilted or flicked.

Hard/Tough/Fibrous

amymillermiuiv — 2025-01-06 16:34:50 UTC

Examples:

Tough meats like steak, pork
Raw vegetables such as carrots, celery, and broccoli
Pineapple, appleskins, oranges, nectarines, peaches
Nuts, seeds, pumpkin seeds
Grapes, chicken skin, salmon skin, sausage skin
Shredded wheat/bran
Beans, rhubarb
Lettuce, cucumber, uncooked baby spinach leaves
Popcorn with hulls
Hard candy
Hard breads (i.e. sub rolls/buns/crusts)

Sticky, Chewy, Gummy

amymillermiuiv — 2025-01-06 16:38:43 UTC

Examples:

Fruit snacks (gummies)
Taffy
Licorice
Thick peanut butter
Dried fruit
Marshmallows
Granola bar (i.e. Quaker granola)
Skittles, Swedish fish, Gummy bears, Starburst
Caramel candy (i.e. Milky Way, caramel creams)
Jerky

Sharp, Spikey

amymillermiuiv — 2025-01-06 16:43:07 UTC

Examples:

Doritos
Nacho/tortilla chips
Taco shells
Wheat thins
Pita chips
Cheez-its
Sun chips

Crispy

amymillermiuiv — 2025-01-06 16:48:36 UTC

Examples:

Thin pretzels
Thin potato chips (i.e. Lay’s)
Graham crackers
Dry cereals (i.e. Kix, Trix, Cheerios, Fruit Loops)
Ritz crackers
Goldfish crackers
Nilla wafers
Cookies (i.e. toll house, sandwich cookies)

Mixed

amymillermiuiv — 2025-01-06 16:52:55 UTC

Examples:

Soup with solids (i.e. chicken noodle soup, vegetable soup)
Cereal with milk
Baked beans in sauce
Fruit cocktail (i.e. fruit cups in juice)
Juicy fruits (i.e. watermelon)

Soft

amymillermiuiv — 2025-01-06 16:57:59 UTC

Examples:

Pasta (i.e. spaghetti, mac-n-cheese)
Pancakes/waffles with syrup
Grilled cheese sandwich
Apple slices without skin
Bananas
Berries (i.e. strawberries, raspberries)
Watermelon
Soft cooked vegetables (i.e. peas, beans, broccoli)
Raw cucumbers without skin
Tomatoes without skin
French fries (soft-cooked)
Cereal bar (i.e. Nutrigrain)
Chicken (soft-cooked)
Ground beef (i.e. burgers, soft tacos)
Cake, muffins, doughnuts
Cookies (soft-baked)
Soft bread

Puree

amymillermiuiv — 2025-01-06 17:01:44 UTC

Examples:

Applesauce
Yogurt
Pudding
Mashed potatoes
Smooth oatmeal

Transitional

amymillermiuiv — 2025-01-06 18:02:55 UTC

Examples:

Hulless popcorn
Cheese puffs/curls
Gerber puffs or ‘Lil crunchies
Veggie Straws

Adult Supervision

amymillermiuiv — 2025-01-06 18:15:51 UTC

Adult in room is aware of dysphagia needs, but able to monitor other children with frequent observation of student with dysphagia, providing prompts and modifications, if necessary, as student works toward independence.

Direct Adult Supervision

amymillermiuiv — 2025-01-06 18:30:23 UTC

Adult in vicinity of child with dysphagia, knowing that the child has a potential for incidence, eyes on student's face at all times, monitoring that the child is following recommendations. May assist with more than one student at a time.

Close Direct Adult Supervision

amymillermiuiv — 2025-01-06 18:31:49 UTC

Adult seated next to or across from student(s) who have dysphagia that regularly require assistance/prompts more frequently. Adult needs to be in close proximity of those students to act quickly if needed. May assist with more than one student at a time.

1:1

amymillermiuiv — 2025-01-06 18:32:55 UTC

One adult supervising only one student with dysphagia, focused on that student and helping them to follow recommendations and guidelines, assisting as needed.

Food selectivity

amymillermiuiv — 2025-01-06 18:53:40 UTC

Never force or coerce to consume presented food and/or drink. Keep all meals and oral experiences positive and pleasant.
Allow student to look at, smell, lick, taste any new items within his/her current diet recommendations/restrictions.
Staff may work with family to pre-determine school menu items that may potentially be accepted. Consider presenting new food(s) prior to preferred food(s) to encourage interaction. Communication of acceptance may be communicated to encourage carryover at home.

Foods that melt

amymillermiuiv — 2025-01-06 19:32:35 UTC

Examples:

Popsicles
Jello
Ice cubes
Frozen yogurt/ice cream
Sherbert
Slushees

Obtain and maintain an upright posture

amymillermiuiv — 2025-01-06 19:47:08 UTC

If student receives PT services, staff may consult with PT for additional seating recommendations.
Positioned upright at 90 degrees with feet flat on floor/hard surface.
Staff should provide assistance as needed for neutral head positioning.
Staff may provide lip/jaw support as needed to improve lip seal and positioning.

Provide verbal, visual, tactile cues, as needed for slow rate, small bites, complete chew, clear mouth prior to talking/drinking/additional bite.

amymillermiuiv — 2025-01-06 19:56:30 UTC

Closely monitor mouth stuffing. Provide verbal, visual, and physical cues as needed to reduce eating rate and bite-size as needed.
Bite size should be limited to bite-sized pieces or level spoonful.
Food may be precut (into bite-sized pieces) prior to presentation.
Encourage student to chew and swallow each bite before taking a drink, talking, or putting more food into their mouth.
Staff may limit items on plate to 1-2 pieces at a time if necessary.
Carefully check the inside of the student's mouth (palate, cheeks, teeth, and tongue) for oral residue throughout the meal and at the end of each meal/snack.
Encourage tongue sweep, puree wash and additional swallows to clear.

Provide visual, verbal and physical cues as needed to reduce eating rate and limit to 1 bite at a time.

amymillermiuiv — 2025-01-06 20:00:13 UTC

limit to one, bite-sized piece at a time

Meals should be limited to 30 minutes and remain upright for 30 minutes following the meal.

amymillermiuiv — 2025-01-06 20:21:11 UTC

ensures efficient mealtime use of energy and provide an adequate period for succesfful digestion.

Outpatient Providers

amymillermiuiv — 2025-01-07 15:06:12 UTC

Outpatient feeding therapy providers from the area are listed for families to explore and determine a good fit for their child's care.

amymillermiuiv — 2025-01-07 15:13:32 UTC

Join Nico, Gabby, Blaze, Jazzy, and/or Keisha during this 1-hour assembly on their first day of lunch in the school cafeteria! They are so excited to eat like the big kids, but aren't exactly sure how they're supposed to behave. Help them learn rules to keep them safe while eating and drinking at school with the use of a familiar song and fun games!

FaS Student Referral Form

amymillermiuiv — 2025-01-07 15:17:28 UTC

Our Feeding and Swallowing team supports students with feeding and swallowing difficulties to become safe and independent eaters by providing school staff with student-specific recommendations while in the school setting.

Contact us!

amymillermiuiv — 2025-01-07 15:26:36 UTC

Please contact us with any questions, concerns or feedback! fsteam@miu4.org

Supervisor, Richael Fertig - richael.fertig@miu4.org

Stacy Edwards - stacy.edwards@miu4.org

Amy Miller - amy.miller@miu4.org

Sarah Slater - sarah.slater@miu4.org

Developmental Milestones

amymillermiuiv — 2025-01-10 16:26:56 UTC

Don't wait to get help if your child is having trouble breastfeeding, bottle-feeding, or eating solid foods. Getting help early can prevent problems with eating and can foster a healthy relationship with food for you and your child.

IDDSI Syringe Flow test

amymillermiuiv — 2025-04-30 13:12:29 UTC

How to test liquid viscosity

IDDSI Level 6 - Soft and Bite-sized Testing

amymillermiuiv — 2025-04-30 13:17:14 UTC

Demonstration videos of testing appropriate preparation of foods in IDDSI Level 6 - Soft and Bite-sized diet

IDDSI Level 5 (Minced and Moist) Testing

amymillermiuiv — 2025-04-30 13:23:23 UTC

Demonstration videos of testing appropriate preparation of foods in IDDSI Level Level 5 (Minced and Moist)

IDDSI Level 4 (Pureed/Extremely Thick) Testing

amymillermiuiv — 2025-04-30 13:34:47 UTC

Demonstrates a spoon tilt test to determine appropriate consistency for pureed/extremely thick items