Speech and Language Therapy - Swallowing advice for a Minced and Moist Diet (Level 5)

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

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 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 minced and moist diet?

A minced and moist diet:

• Should be very soft and needs little to no chewing. No biting is required
• Lumps are easy to squash with the tongue
• Mashable with a fork into small soft lumps (4mm). When pressed with a fork, the lumps should come through the prongs of a fork easily
• Requires a thick, smooth sauce or gravy

NOTE: Tough meats and difficult textures will need to be blended.

Foods NOT suitable for a minced and moist diet:

• Hard, tough, chewy, stringy, dry, and crispy textures
• Foods with skins, husks or outer shells e.g. peas, grapes, sweetcorn
• Crunchy foods such as lettuce or cucumber
• Hard textures e.g. pieces of apple or cheese chunks
• Food and liquids mixed together e.g. soups with lumps/bits or cereal in milk
• Ice cream is not suitable for people having thickened fluids
• No bread
• No juicy fruit with thin liquid such as watermelon
• No dry rice. Any rice should not separate into individual grains

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

How food is tested to make sure it is Level 5 Minced and Moist? 

It is safest to test Level 5 minced and moist foods using the fork test and the spoon tilt test (see diagram below). The food should be mashable and able to come through the prongs of a fork easily.

IDDSI fork test - For adults the lump size is 4mm, which is about the gap between the prongs of a standard dinner fork.

IDDSI spoon tilt test - The food holds its shape on the spoon and falls off fairly easily if the spoon is tilted or lightly flicked. It should not be firm or sticky.

Minced and moist food must pass both tests!

Specific food groups

Meat

• It can be stewed or cooked in a casserole until tender. It should be minced into 4mm pieces or fully blended if it cannot be mashed

Fish

• Finely mashed in a thick, smooth sauce or gravy

Vegetables

• Finely minced/mashed
• Drain any liquid

Rice

• Should be cooked in a thick sauce e.g. risotto or rice pudding
• Should not separate into individual grains

Fruit

• Served mashed
• Drain excess juice

Cereal

• A fully softened weetabix or a thick smooth porridge with no lumps

Milk must not be separate from the cereal e.g. weetabix should be well combined with the milk.

Desserts

• The texture of a THICK smooth yoghurt or stewed apple in thick custard

No bread unless fully soaked in a liquid e.g. soup. Please discuss with your Speech and Language Therapist on an individual basis.

Suggested minced and moist diet meal ideas

Breakfast

• Porridge
• Weetabix soaked in milk
• Hot oat cereal e.g. Ready Brek, no lumps

Main meals

• Mashed fish e.g. tinned tuna or salmon in mayonnaise
• Mashed corned beef/potato hash/fish pie
• Quiche without the pastry (mashed)
• Mashed potato
• Mashed boiled vegetables without skins
• Lentil based dishes (well cooked), such as dhal
• Crumb free fish cake with mashed sweet potato and mashed avocado

Snack meals

• Mashed poached eggs or scrambled eggs
• Thick soups containing bits no bigger than 4mm
• Tender spaghetti bolognese cut up into 4mm pieces
• Mashed jacket potato (no skin) with butter, tuna mayonnaise or egg mashed with mayonnaise or salad cream
• Salmon or mackerel mousse with ripe, mashed avocado

Puddings

• Custard and stewed fruit (skins removed) or mashed bananas
• Milk puddings

Soft minced and moist snacks

• Porridge or instant hot cereal e.g. Ready Brek or Weetabix served with hot milk
• Soft mashed fruits
• Mashed stewed apple with sugar (no skin)
• Banana mashed with milk, cream or custard
• Yoghurt (not muesli type) - thick and creamy varieties, Greek yoghurt
• Fromage frais
• Mousse and crème caramel
• Milk pudding with Jam - home-made, tinned or packet pudding such as custard, semolena, rice pudding and sago are suitable.
• Sponge puddings served with cream or custard (mashed and mixed well)
• Angel delight or instant whip
• Ice-cream, Blancmange
• Baked egg custard mashed with a fork (no pastry)

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 (please see the list of Minced and Moist snacks)
• 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 soft or pureed meals

Wiltshire Farm Foods – Soft and puree main meals and puddings
http://www.wiltshirefarmfoods.com

Hermolis – Kosher food specialists
http://www.hermolis.com

Punjab Kitchens – Modified main meals and puree puddings – Halal food specialists
http://www.punjabkitchen.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
Email: office.complaints@nca.nhs.uk
Telephone: 0161 656 1141