Guidelines for the Progression of Food Textures

Level 1: Pureed Foods

• Avoid the use of commercially prepared strained (baby) foods. The taste difference will make the transition to table foods more difficult.
• Puree regular table foods to the consistency of strained foods by using a household blender. Allow several weeks for the child to adapt to the change in taste.
• Progress to Level 2 when the child displays a predominant sucking action during feeding, but cannot move food to the sides of the mouth using the tongue.

Level 2: Thickened Pureed Foods

• Thicken pureed foods in order to facilitate certain tongue and jaw movements which are unnecessary to ingest thinner foods. Nutritious thickeners include mashed potato flakes, wheat germ, bread crumbs, or dry baby cereals. Thicker pureed foods may also be produced by using less blender action.
• Include other nutritious foods such as oatmeal or cream of wheat, mashed potatoes, mashed banana, applesauce, or yogurt.
• Progress to Level 3 when the child begins to display vertical (up and down) chewing.

Level 3: Ground Foods

• Grind regular table foods by using a small baby food grinder, or a food chopper, both of which may be purchased at most department stores. A household food processor may be used for grinding larger quantities of food.
• Include ground meats with broth or gravy, ground or mashed cooked vegetables and fruits, scrambled egg, mashed soft-boiled egg, egg salad, cottage cheese, pimento cheese, or prepared meat salads.
• Offer foods designed to stimulate biting and chewing such as toasted bread strips or crusts, dried fruits, cheese strips, cooked vegetable pieces, and strips of meat. Note that the child may have difficulty with raisins, grapes, or meats which require shearing or tearing.
• Progress to Level 4 when the child begins to move foods from side to side by using the tongue.

Level 4: Chopped Foods

• Obtain textures for this stage by chopping meats, fruits, and vegetables into small bite-size pieces by using a knife rather than the blender, food processor, or baby food grinder. Meats, fruits, and vegetables should be cut into bite-size pieces.
• Include chopped meats and casseroles, chopped cooked vegetables, chopped fruits, grilled cheese or chopped meats sandwiches, and finely chopped slaw or salad.
• Progress to Level 5 when the child has a mature rotary chew and freely moves food from side to side in the mouth. However, some children with dysphagia may never progress to this advanced level.

Level 5: Coarsely Chopped Foods

• Include small pieces of chopped meats, fruits, and vegetables, coarsely chopped salad and slaw, and cornbread.

Source: From Shaddix, T., & Barnacastle, N. (1986). Nutritional care for the child with developmental disabilities--Oral motor development and feeding techniques. Birmingham, AL. United Cerebral Palsy of Greater Birmingham.