Speech and Language Therapy - Swallowing advice for a Liquidised Diet (Level 3)

Contact Numbers:

Please ONLY contact your local community team

Salford Speech and Language Therapy Department
Ladywell Building
Community: 0161 206 2333
Hospital: 0161 206 5450
Email: adult.salfordslt@nca.nhs.uk

Oldham Speech and Language Therapy Team
Integrated Therapy Hub
Telephone: 0161 770 2300 (Option 5)
Email: saltoldhamadults@nca.nhs.uk
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Bury Speech and Language Therapy Team
Bury Living Well Centre Telephone: 0161 206 0576
Email: buryadultsalt@nca.nhs.uk

Why is it important to follow the Speech and Language Therapy recommendation?

Following your assessment with the Speech and Language Therapist you will be given specific advice regarding suitable food types.

It is important to follow these recommendations as you may be at risk of the food ‘going down the wrong way’ which is known as aspiration. This may lead to coughing after eating and may cause a chest infection.

If you experience any difficulty with your swallow such as coughing when eating or drinking, frequent chest infections, or feel your swallow deteriorating please contact your Speech and Language Therapist for further advice or assessment.

What is a liquidised diet?

A liquidised diet:

• Should have a smooth texture with no bits, lumps, or skins
• Should need no chewing
• Can be eaten with a spoon or drunk from a cup

A liquidised diet CANNOT:

• Be eaten with a fork as it drips through the fork prongs
• Be piped, layered or moulded on a plate as it will not keep its shape

Why is this thickness level used for adults?

Level 3 Liquidised foods may be used if people have difficulty moving their tongue. The consistency gives more time for the tongue to “hold and move” the liquidised food, than with thinner consistencies.

It is easiest to eat liquidised food with a spoon. Seek help about nutrition when using this texture to be sure the person is getting the right amount of nutrition to meet their needs.

There is further information towards the end of this booklet about what to do if a person is losing weight.

This advice is written for adults. If under 16 years old, please refer to separate paediatric guidelines.

How to prepare liquidised food

• It usually requires preparation with a blender or food processor. Food may require sieving after blending to get a fully smooth texture

• Food should be cooked as per cooking instructions and cut into small pieces before blending
• It will need to be blended with a liquid to achieve the right consistency. Liquids to use can be gravy, milk, or stock – water should not be used as it is not nutritious
• If the food becomes too thin, thickener can be added to gain the correct texture e.g. cornflour or instant mashed potato, or thickener.
• Ensure that the food is as tasty as possible by adding flavourings such as spices and lemon
• Avoid all nuts or seeds, stringy food such as celery or onions and foods with a tough skin such as dried beans, peas or corn as these foods do not puree well
• Where possible, try and serve different liquidised foods separately so there are individual portions of each food on the plate. A plate with dividers, or using small bowls, may help presentation so the food does not spread on the plate

How is food tested to make sure it is Level 3 Liquidised?

It is safest to measure the thickness of liquidised food using the IDDSI flow test and the IDDSI fork drip test. With the IDDSI fork test, the liquid should drip slowly through the prongs of a fork, as seen in the picture below.

The IDDSI flow test measures how thick a liquid is by how fast it flows through a 10ml syringe in 10 seconds. A specific syringe is needed for this test (shown below). Before the test you must check the syringe length as there are differences in syringe lengths. Your syringe should look like this:

There should be no less than 8ml remaining in the syringe after 10 seconds of flow. If you require any help with this, please speak to your Speech and Lanquage Therapist.

See the instructions below on how to carry out the flow test.

To view the testing method in a video, please search for IDDSI flow test level 3 on YouTube.

Level 3 food and drink ideas

At the time of serving, ensure all of the following foods pass the level 3 tests stated previously.

Breakfast

• Liquidised porridge or instant ground oat cereal made with full cream milk or double cream. Add sugar, honey or syrup to taste. Please ensure all milk or cream is soaked in. Additional fluids may need to be added to achieve a Level 3 consistency, but there should be no loose fluids once prepared
• Runny yoghurt or fromage frais (no bits) with liquidised fruit
• Liquidised scrambled egg with liquidised beans
• Liquidised fruit with added cream, runny yoghurt or fromage frais

Lunch

• Thick smooth liquidised soup/broth
• Cauliflower cheese or macaroni cheese liquidised to smooth consistency by thinning with stock
• Tinned pasta, e.g. ravioli or spaghetti liquidised to smooth consistency with stock
• Liquidised potato with liquidised cottage cheese
• Liquidised beans or spaghetti, that are thinned with stock

Main meals

• Flaked fish in cheese sauce liquidised to a smooth consistency
• Stewing steak or chicken casserole liquidised to a smooth consistency
• Liquidised potato with double cream and butter
• Liquidised meat or fish
• Liquidised smooth vegetables
• Lasagne liquidised to a smooth consistency with cream/stock
• Liquidised corned beef with liquidised potato

Puddings

• Liquidised milk puddings (e.g. rice pudding, semolina, set custard) with milk or cream
• Instant desserts or whips in a runny consistency
• Fruit fools, smooth set fruit yoghurt, fromage frais or mousse
• Liquidised fruit with whipped cream or thin custard
• Whipped cream, fromage frais or thin custard liquidised with cake

Fruit smoothie recipe

Ingredients:

• ½ banana cut into pieces
• 75g blueberries or strawberries
• 2 dessert spoons vanilla yoghurt
• 450ml milk
• Juice of 1 orange (ensure no pips)
• 1 teaspoon of honey

Instructions:

1. Place the ingredients into a blender and blend for approximately 2 minutes until smooth.
2. Pass through a fine sieve to ensure there are no pips or seeds.
3. Check the consistency passes the test for Level 3 Liquidised diet.

What to do if you are losing weight?

• Aim for a ‘little and often’ meal pattern (3 small meals and 3 snacks per day)
• Have nourishing drinks between meals (Milk, Horlicks, Ovaltine, hot chocolate)
• Have high energy drinks (Build Up or Complan) which are available from your chemist in-between meals and not as a meal replacement.
• Have nourishing snacks between meals smooth yoghurts, instant hot cereal or weetabix with hot milk, liquidised soft fruit or tinned fruit, fromage frais, mousse and crème caramel
• Use only full fat products (Full fat milk, thick and creamy yoghurts, Full fat cheese)
• Try ‘fortifying’ your food by making foods that are higher in energy and protein without increasing portion size

Food Fortification

• Add skimmed milk powder to foods (Add 2 to 4 tablespoons into a pint of full fat milk or 1 tablespoon into porridge or soup)
• Add double cream, condensed milk or evaporated milk to foods before pureeing (add to porridge, custard, mashed potato, soups, vegetables and milky drinks)
• Add grated cheese to foods before pureeing (mashed potato, scrambled eggs, vegetables, and soups)
• Add margarine or butter to foods before pureeing (mashed potato, vegetables, and milk puddings)
• Add extra sugar, syrup or honey to cereals, drinks and puddings but please take caution if you have diabetes

If you experience weight loss you can ask your GP to refer you to a Dietitian for further advice.

Buying prepared liquidised meals

Simply Puree

A range of Level 3 Liquidised meals - https://simplypuree.co.uk/

Patient Advice and Liaison Service

The Patient Advice and Liaison Service (PALS) acts on behalf of service users, families, and carers to negotiate prompt solutions and help bring about changes in the way that services are developed.

As well as providing a confidential advice and support service, PALS will help guide you through the different services available from the NHS.

Telephone: 0161 778 5665
Email: pals@nca.nhs.uk.

Alternatively, you can write to: PALS Department, The Northern Care Alliance NHS Foundation Trust, Unit 7/8 Whitney Court, Southlink Business Park, Hamilton Street, Oldham. OL4 1DB

Comments and complaints

We want to learn from comments and complaints about our services. If you have any, please speak with a member of staff. Every effort will be made to resolve any concerns and complaining will not cause any difficulties in your care with us.

You can also contact our Complaints Department via post at: Complaints Department, The Northern Care Alliance NHS Foundation Trust, Unit 7/8 Whitney Court, Southlink Business Park, Hamilton Street, Oldham. OL4 1DB
E-mail: office.complaints@nca.nhs.uk
Telephone: 0161 656 1141