Swallow and Nutrition Support - Minced & Moist Level 5 Diet

Supplementing your diet

Sometimes you may feel that you do not want to eat as much as usual. When your appetite is poor, it is important that you eat nutritious foods. This is particularly important if you have lost weight or are recovering from illness or surgery. Try some of the ‘top tips’ below:

Loss of appetite

• try to eat the most at the time of day when your appetite is at its best
• serve smaller, manageable portions and make the food look as attractive as possible
• have a rest between courses
• rely on your favourite foods and eat foods you enjoy
• fresh air or a short walk before your meal may help stimulate your appetite
• drink suitable fluids after a meal and not with a meal as they may fill you up.

Ways to increase the calories in your diet

• try smaller, more frequent meals with snacks and nourishing drinks between them
• try adding soft cheese to soups, mashed potatoes and other savoury dishes
• cover vegetables such as cauliflower and broccoli with a cheese sauce
• add evaporated milk or cream to puddings
• be generous with butter, margarine or oil in cooking
• add jam, syrup or honey to puddings and breakfast cereals.

Snack ideas

• thick and smooth fortified soup and fortified milk (see recipes below)
• cheesy mashed potato
• guacamole and pureed carrots
• milky puddings or custard made with full-fat milk or fortified milk
• full-fat yoghurt with puréed fruit
• bowl of soft cereal or porridge
• fortified drinks such as Meritene or Complan are available from supermarkets or chemists

Fortified milk 

Ingredients

1 pint or 600ml of full fat milk
4 tablespoons of skimmed milk powder 

Method

Mix the milk powder to a paste with a little of the milk, then stir in the rest of the milk. 
This fortified milk can be used in drinks, breakfast cereal or wherever you would normally use milk

Fortified soup

• add fortified milk, instead of water to condensed soup or cup-a-soup before
  liquidising OR 
• add milk powder, cream, soft cheese, and/or olive oil to homemade or puréed
  canned soups.

Remember; drinks may need to be thickened according to your speech and language therapist’s advice.

Starchy carbohydrates acceptable for a minced and moist diet, and those to avoid

Acceptable for minced and moist diet	Avoid
Smooth, cooked, rolled oats or semolina Baby cereals eg. baby rice Cereal soaked in milk and mashed (Weetabix, All-Bran with no loose fluids) Mashed pasta and rice dishes: creamed rice mashed macaroni cheese mashed meat and pasta dishes mashed tinned spaghetti, ravioli potatoes, sweet potatoes, yams boiled or mashed in gravy or sauce; the inside of a jacket potato, mashed potato salad.	Muesli or cereals with added dried fruit and nuts Bread, crumpets, and muffins Cakes, pies, pastries, and biscuits Dual consistency cereal and milk Couscous Noodles Naan bread and chapatti Toast, bread, dry pasta without sauce Savoury rice

• Meat must be finely minced, with pieces approximately 4mm with no hard bits. Serve in a thick, smooth, non-pouring sauce or gravy. If meat cannot be finely minced it should be puréed.
• Casseroles, stews and curries must be thick and prepared as above.
• Fish must be served finely mashed and in a thick, smooth, non-pouring sauce or gravy.

Meat and meat alternatives acceptable for a minced and moist diet, and those to avoid

Acceptable for minced and moist diet

Avoid

Minced meat and casseroles, eg. beef, lamb, chicken, turkey Soups containing meat or poultry – blend or mash and strain off any thin liquid; add mashed vegetables for taste and nourishment  Boneless fish fillets, steamed or grilled; fork-mashed with white sauce Canned tuna or salmon, minced as above Legumes, eg. chickpeas, lentils, kidney beans, well-cooked or canned – then mashed with enough liquid to form desired consistency Baked beans and skinless sausages, mashed Hummus Smooth pâté Scrambled eggs, omelettes or poached eggs, well mashed.

Tough, stringy or dry meat, fish or poultry Bread-crumbed meat Coarse or lumpy pâté Grilled meat Sausages, salami, frankfurters, bacon lardons, ham,  pancetta Any meat, chicken, or fish that is not minced or mashed Fish with bones Eggs, boiled or fried Pies and sausage rolls Nuts, seeds, crunchy nut butters

A guide to your daily intake

It is important to eat food from each of the core food groups every day. These are:

• starchy carbohydrates
• fruit and vegetables
• meat and meat alternatives
• milk products. 

Seek further information from your dietitian.

Fruit and vegetables acceptable for a minced and moist diet, and those to avoid

Acceptable for minced and moist diet

Avoid

Smooth vegetable soups Mashed stewed or tinned fruit, eg. apple, pear, apricot, peach, plum Mashed soft fresh fruit, eg. pawpaw, banana, mango; peeled and ripe nectarines, peaches, pears, plums Summer Pudding with cream or custard Well-cooked then mashed fresh, frozen or canned vegetables eg. carrots, sweet potato, turnips, cauliflower, squash, courgette, broccoli, potato, pumpkin, mushy peas, swede Strained tinned tomatoes Vegetables can be added to stews, soups, and casseroles, which can be minced and strained.

Dried fruit Unpeeled fruit Hard fruits, fresh apple, pineapple, passion fruit, oranges, berries and coconut Compote of fruit, eg. cherry with hard skin, or fruit with thin juice Stringy or tough vegetables, eg. celery, sweetcorn, peas, beans, tomatoes Vegetable skin and seeds Raw vegetables and salads Undercooked or crunchy vegetables Soups with lumps.

 

Milk and milk products acceptable for a minced and moist diet, and those to avoid

Acceptable for minced and moist diet	Avoid
Plain or strained fruit yoghurt Yoghurt desserts, eg. fruit fool Custard Soft smooth milk puddings, eg. cheesecake without crust, mousse, instant pudding Ricotta cheese, cream cheese Grated cheese, melted cheese Cheese sauce Dips and spreads Rice pudding or tapioca.	Ice-cream with nuts or ‘bits’ Grilled cheese or hard cheese Packaged cheese cubes or slices Unstrained fruit, nut, wholegrain or muesli yoghurt.

Puddings and snacks acceptable for a minced and moist diet, and those to avoid

Acceptable for minced and moist diet

Avoid

Blancmange, instant whip style puddings Jelly, milk jelly, fruit sorbet, trifle with no fruit pips and very soft fruit Soft fruit crumble with ice cream or custard Soft sponge cake, fully softened by mashing with thick, smooth custard Shop-bought mousse desserts, eg. caramel, Rolo, Milky Bar, Aero chocolate mousses Crème caramel Egg custard with no pastry Thick, smooth yogurt Stewed fruit with no pips or skins in thick custard.

Pastry Crisps Biscuits Cakes Sweets, toffees Muesli bars.

Before eating and drinking please ensure that the person who is eating:

• can remain consistently awake and alert during eating and drinking
• is able to sit as upright as possible
• has a clean and clear mouth.

During eating and drinking please ensure that the person who is eating:

• has the correct texture of diet and fluids recommended by the speech and 
  language therapist
• if you are feeding, explain what you are doing and what the person will be eating and drinking
• ensure the mouthfuls provided are not too large 
• concentrate on each swallow
• monitor for any coughing, ‘gurgly’ voice, increased respiratory rate or fatigue. If  you notice any of these symptoms, stop and contact the community speech and language therapist for advice. 

You may also need to:

• remind the person eating to swallow more than once each time to clear any 
  residue 
• allow extra time between mouthfuls for extra swallows

At the end of eating and drinking:

• ensure the person’s mouth is clear and clean
• keep the person sitting up for 30 minutes, to minimise the risk of reflux
• medication may also need to be modified in line with eating and drinking guidelines. Please speak to your pharmacist for advice.

If you are on texture modified fluids (thickened drinks) a speech and language therapist may advise you to avoid ice-cream and jelly. This is because ice-cream and jelly change consistency in your mouth, and become too runny. Please speak to your therapist if you are unsure. 

If you would like more information on how to prepare a puréed diet please visit the IDDSI website www.IDDSI.org. You can also find information on how to use the fork test and spoon tilt test to check that your food is the correct consistency.

Who should I contact if I have a problem or question?

If you have concerns regarding swallow safety or aspiration, contact your GP who can put you in touch with your local Community Speech and Language Therapy Team.

Dietetic Department, Hillingdon Hospital: 01895 279416

What should I do in case of an emergency?

Contact your GP or call 111 if non-urgent. Attend A&E or call 999 if an emergency.