Swallow and Nutrition support - easy to chew diet, Level 7

Swallow and Nutrition support - easy to chew diet, Level 7

What is an easy to chew diet?

  • soft and tender food that is safe to swallow without tiring easily
  • any method can be used to eat these foods eg. fingers, fork, spoon etc.
  • avoids foods which are hard, tough, chewy, fibrous, have stringy textures, pips, seeds, bones or gristle.

Why do I need an easy to chew diet?

Easy to chew food may be used if you are able to chew soft or tender foods into smaller pieces without assistance or cut the food into small pieces. This texture may be right for you if you usually choose to eat soft food, as you find chewing hard foods difficult and fatiguing. It may also be a good choice if you have been unwell and are recovering strength.

Food preparation hints 

Meat: cooked until tender
Fish: cooked soft enough to break apart easily with the side of a fork or spoon.
Fruit: should be soft enough to break apart into smaller pieces with the side of a fork  or spoon. Be careful when eating fruit with high water content, where the juice  separates from the solid in the mouth during chewing
Vegetables: should be steamed or boiled until tender. Stir-fried vegetables will likely be too firm any may need to be avoided
Cereal: should be served with the milk softening any hard pieces. Any excess liquid  should be drained before eating
Rice: does not have any special cooking requirements at this level.

Cook ahead and freeze meal portions to save yourself time. Check before serving and eating that no hard pieces or lumps have formed during cooking or heating or while the food has been standing.

Supplementing your diet

Sometimes a puréed diet may not be enough to meet your nutritional requirements, especially if you have a small appetite. If your portions are smaller than normal, it is important that you eat foods that are nutritionally dense. Try some of the ‘top tips’ 
below:

  • eat your most filling meal of the day when your appetite is at its best
  • serve smaller, more manageable portions
  • have snacks or nourishing drinks between your meals
  • eat foods that you enjoy
  • fresh air or activity before your meal may help stimulate your appetite
  • use whole milk if possible
  • if possible add cheese, butter, or sour cream to puréed potatoes 
  • cover vegetables such as purée cauliflower and broccoli with a cheese sauce
  • add evaporated milk or cream to puddings such as Angel Delight and custards 
  • be generous with butter, margarine or oil in cooking puréed meals
  • add jam, syrup, sugar or honey to drinks, puddings or breakfast cereals

Snack ideas

  • thick and smooth fortified soup and fortified milk (see recipes below)
  • cheesy mashed potato
  • smooth guacamole and puréed carrots
  • milky puddings or custard made with full-fat milk or fortified milk
  • full-fat yoghurt with puréed fruit
  • a bowl of porridge made with full-fat milk or fortified milk and honey.

Nourishing drinks

If you are unable to manage a full meal you can increase your intake with nourishing drinks. Try the following suggestions:

  • make a smoothie with puréed fruit, honey, ice cream and fortified milk
  • replace water with fortified milk to make a creamy coffee
  • add cream to hot chocolate
  • try Complan or Meritene drinks, available from chemists and supermarkets.

Recipes

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.

High-risk foods - easy to chew diet

High-risk foods

The following foods may be more difficult to eat and should be avoided:

  • Stringy, fibrous textures eg. pineapple, runner beans, celery, lettuce
  • Vegetables and fruit with skins eg. beans, including broad beans, baked beans, soya beans, black eye beans, peas, sweetcorn and grapes
  • Crunchy foods eg. toast, flaky pastry, dry biscuits, crisps
  • Crumbly items eg. bread crusts, pie crusts, crumble, dry biscuits
  • Hard foods eg. boiled and chewy sweets and toffees, nuts and seeds
  • Husks eg. sweetcorn and granary bread.

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.

Swallow safety advice

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.