Dysphagia Snacks From Around The World

We get many requests for dysphagia IDDSI recipes. These come from both the UK and from all over the world. Recently we were asked for advice on how to make dysphagia barfi. We are really connected to the global phenomenon that is IDDSI!

The UK is such a wonderfully multicultural place, and, working in the health and social care sector it is a real privilege to meet and work with people from all around the world. Food has always been a great subject to connect and develop long lasting relationships. This diversity and love of food is mirrored in those we care for.


Multicultural requests

We were approached by the clinical SLT team in Cardiff and Vale NHS Health Board for tips on how to make mithai, barfi, ladoo, jalebi, gulab jamun, gajar halwar and samosa suitable for the IDDSI Framework!

I must admit, I did have to search the internet to understand what some of the snacks listed are! But with that knowledge, and the use of ORAL it is simple to create a recipe.


Applying ORAL

Our ORAL approach to dysphagia diets focuses on ingredients. This means any regional and cultural variances can be accommodated. In fact any dietary requirements are  easily incorporated: allergens, lifestyle choices, religious, diabetic, fortification…


Dysphagia barfi

Now, before you read the recipe below, for what is essentially a base recipe for dysphagia barfi, I am now expert in this area of cookery! Please, be kind, and substitute flavourings as you wish. I have suggested these flavourings:

  • Rosewater
  • Cardamom and cinnamon
  • Orange, lemon and clove

The setting agent in the recipe is vegetarian, and using different quantities of this will allow you to make IDDSI Levels PU4, MM5, SB6 and EC7.

World foods similar to cakes, biscuits and pastries can also be used using the techniques discussed in our dysphagia cakes and biscuits article.

Reform Processes: Texturise and Resize.



150g Condensed milk

250g Coconut cream


5g Rosewater

5 Cardamom pods (crushed) and 5 cloves

The zest of an orange, a lemon and a cinnamon stick

Texturising Agent:

PU4: 0.5g Carrageenan Iota

MM5: 1.5gCarrageenan Iota

SB6 and EC7: 2g Carrageenan Iota

Reform Processes


Barfi Cream

  1. Texturise the infused cream mixture with the carrageenan iota
  2. Resize the set barfi cream for the IDDSI Level required


    1. Add the condensed milk, coconut cream and chosen flavourings to a pan and bring to the boil.
    2. As soon as the mixture starts to boil, remove from the heat and allow to cool.
    3. Infuse the flavourings into the cream mixture, in the fridge, for a couple of hours or overnight.
    4. Strain the mixture into a pan and whisk in the required amount of carrageenan iota.
    5. Bring the mixture to the boil to activate the carrageenan.
    6. For Level 4 – Pureed: pour the mixture into small dishes to cool and thicken in the fridge.
    7. For all other IDDSI Levels: pour into a tray lined with clingfilm and allow to set in the fridge.
    8. Resize to the required IDDSI Level by cutting to the correct size.

DDSI Audit – Use appropriate IDDSI Level Audit Sheet

IDDSI Testing Methods:

  • PU4 – No lumps, IDDSI Fork Drip Test and IDDSI Spoon Tilt Test
  • MM5 – Lumps no larger than recommended size, IDDSI Fork Pressure Test, no separate thin liquid
  • SB6 – Lumps no larger than recommended size, IDDSI Fork Pressure Test

Quality Audit: 5/5

Nutrition – 1/1
Flavour – 1/1
Colour – 1/1
Smell – 1/1
Composition – 1/1


Audit and serve the food at a temperature around 10-15C.