An Introduction to Transitional Foods

As defined by the IDDSI framework, transitional foods “start as one texture (e.g., a firm solid) and change to another texture specifically when moisture (e.g., water or saliva) is applied or when a change in temperature occurs (e.g., heating or the warmth of your mouth).”

The following are examples of potential transitional foods. The person with dysphagia and/or the caregiver should always test the item to make sure that it is a transitional food (see below and page 10 of IDDSI’s Testing Methods). Some transitional foods may be harder for a person with dysphagia (e.g., gelatin), while other items may be easier. Please follow the guidance of your dysphagia specialist (speech-language pathologist/SLP).

• Ice chips, popsicles
• Gelatin (e.g., Jell-O brand)
• Ice cream
• Some wafers (e.g., religious communion wafers)
• Some baby teething wafers, but all teething wafers need testing prior to giving them to your child. (See Barewal et al., 2021 regarding the poor dissolvability of Baby Mum Mums™ and other products; See Awadalla et al., 2018 regarding analysis of first finger foods)
• Some specific crackers or cookies that are made to dissolve easily in the mouth (See Barewal et al., 2021 and Savorease™)

In short, there are two types of transitional foods; some transitional foods melt down to a thin liquid with the heat of the mouth, while others are a unique food texture that once the solid has been broken down by moisture and temperature, then minimal chewing is required and even tongue pressure alone can break down these items.

IDDSI recommends the following testing regimen for transitional foods:

1. Apply 1ml of water to your food sample (this can be done via syringe).
2. Wait 1 minute.
3. Perform the IDDSI Fork Pressure Test
   1. Use a standard fork
   2. Apply pressure to the base of the fork with your thumbnail until your thumbnail blanches white
   3. The sample should melt, disintegrate, or squash, leaving indentations of the fork. It will not return to its original shape after releasing the pressure.

While transitional foods have shown great promise as a potential bridge between pureed foods and solid foods, there’s still been very little research done on this topic. In fact, IDDSI has only two recommended articles noted in their frequently asked questions section on transitional foods (Gisel, 1991 and Dovey, Aldridge & Martin, 2013). But there’s optimism towards using transitional foods as a way to help develop important chewing and swallowing skills for those challenged by dysphagia, or as a substitute for those with oral sensitivity issues. Drs. Reva Barewal and Samantha Shune and colleagues recently published an article on transitional foods in the Dysphagia Journal. The authors highlighted the key point to expect variability within people and between different products. They cautioned that even when a product states that it is a transitional food or that it is a first finger food, one must consider the following:

• Quality and quantity of saliva to add moisture
• Type and severity of dysphagia (your SLP can perform individualized testing)
• How long will the food be held in the mouth, as people tend to only contain food in the mouth for 12 seconds versus the 1-minute length of time in the IDDSI testing method.

Therefore, in addition to the IDDSI testing methods, it is wise for a caregiver without dysphagia to first test the food by placing it in their own mouth. When you hold the food on your tongue and apply some up and down tongue pumping, the sample should start dissolving into a paste in about 12 seconds (Barewal, et al., 2021).

Barewal and colleagues (2021) emphasized the benefits of transitional foods for improving quality of life and more. For example, providing crunchy transitional food textures for people on pureed diets can satisfy food preferences, increase caloric intake at snack time, retrain chewing motions, and potentially foster diet texture advancements for people with dysphagia. Another example is from Japan, where healthcare professionals use a dysphagia training jelly for safer swallowing retraining during treatment, as this jelly does not thin down to a thin liquid in the mouth like typical American gelatin (Jell-O). Applications like these give hope that transitional foods can help aid in a return to quality of life for those on dysphagia diets.

To learn more about transitional foods and their relationship with dysphagia, check out the full three-part series on transitional foods from Karen Sheffler, MS, CCC-SLP, BCS-S.

*This author, Karen Sheffler, does not have a financial relationship with any of the mentioned products.