Holland Bloorview has advanced client safety and quality care by fully adopting the International Dysphagia Diet Standardisation Initiative (IDDSI) standard. Dysphagia is the medical term for the symptom of difficulties in swallowing and it’s estimated to affect about eight per cent of the world’s population.  Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. 

The global IDDSI framework standardizes terminology and definitions for food and liquid textures, ensuring safer, more consistent nutrition for clients with swallowing difficulties.

Approximately 30 to 50 per cent of daily diets for inpatient clients are specialized, including textured diets. Staff have embraced the change and ongoing training ensures the standard is maintained. 

Why IDDSI matters

Prior to IDDSI, hospitals and care organizations used different labels and terminology for texture descriptions, creating confusion for clients and caregivers, especially during transitions between health care institutions. By adopting IDDSI, Holland Bloorview joins a growing network of hospitals around the world working towards unified standards, while improving communication and safety for clients and their families.

“Adopting IDDSI is a critical step in ensuring the safety and well-being of children with complex medical needs,” says Dr. Andrea Hoffman, developmental pediatrician and physician lead on the project. “For these children, even small inconsistencies in food or liquid textures can pose significant risks. By standardizing terminology and practices across care settings, IDDSI empowers families and care teams to provide safer, more consistent nutrition—supporting seamless transitions between hospitals and reducing confusion both in hospital and at home in the community.”

A multidisciplinary, collaborative team 

A multidisciplinary and highly collaborative team was responsible for achieving this major milestone.  Dietitians, physicians, speech language pathologists and an occupational therapist were among those involved.  The implementation team also drew membership from Holland Bloorview’s quality, safety and performance team as well as information management and technology. 

Another essential partner was Sodexo, a long-time provider of retail and inpatient food service at Holland Bloorview.  Over multiple iterative phases that included research, education and kitchen testing, IDDSI was first launched in March 2023. The majority of the seven levels were launched during this initial phase.   The standardized initiative was fully implemented in August 2025.

“Implementation of IDDSI has been a valuable learning experience for everyone involved,” says Rebecca Perlin, a speech language pathologist involved in the project from the beginning. “Standardized terminology helps make clearer, more consistent recommendations for clients and families and has all of us, including clinicians, physicians, and food services staff speaking the same language when it comes to food texture preparation.” 

Holland Bloorview has presented its implementation approach at international conferences, including, most recently, the American Academic for Cerebral Palsy and Developmental Medicine meeting in New Orleans in October 2025. 

“This is an incredibly important accomplishment and a reflection of the organization’s deep commitment to caring safely as we strive for zero harm across the hospital,” says Stewart Wong, vice president, communications, strategy and sustainability, whose portfolio includes food service. "It also reflects the culture of excellence at Holland Bloorview, where collaboration across diverse teams continues to drive meaningful change and inspire success."

For more details on the IDDSI framework, visit iddsi.org/framework.

By Erin Pooley