Hierarchy of Swallowing Difficulty

There are variations in what is most difficult for a person to swallow but this is generally the easiest to the hardest.  When doing an assessment I start with ice chips then progress through the lists below, stopping if there is obvious, repeated aspiration. 

Solids:
Puree
Mechanical Soft
Regular Texture

Liquids:
Pudding Thick
Honey Thick
Nectar Thick
Thin

If you or one of your family members have been placed on a restricted diet here is a list of items that naturally falls into each category.


Puree: mashed potatoes, pudding, yogurt
Mechanical Soft: cooked fruits and vegetables, chopped meats with gravy, cottage cheese, cheese
Regular Texture: meats, crackers, raw fruits/vegetables, breads

Pudding Thick:  I cannot think of any-this is generally achieved with a thickener additive like Thick-It or SimplyThick (simply thick should not be used for infants!)
Honey thick: thick milkshake
Nectar Thick: Kerns Nectar, buttermilk, thin milkshake, tomato juice, V8, cream soups
Thin: water, milk, apple juice, tea, coffee, broth, Jello (Jello is often mistaken to be thickened liquid or a puree solid.  This is not the case!!!  When it is in your mouth it melts into a thin liquid and can cause aspiration if a person is on a restricted diet.)