Speech and Language Therapy - Swallowing advice for a Regular Easy to Chew Diet (Level 7)

Contact Numbers:

Please ONLY contact your local community team

Salford Speech and Language Therapy Department
Community: 0161 206 2333
Hospital: 0161 206 5450
Hospital Stroke Department: 0161 206 2142
Community Stroke and Rehabilitation: 0161 206 2352
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 recommendations?

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 choking or of 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 Level 7 Regular 'easy to chew' diet?

• Normal, everyday foods that have a soft/tender texture
• Foods may be a range of sizes. There is no restriction on food piece size in this level
• Food can be cut or broken apart easily with the side of a fork or spoon. It should not need a knife to cut it
• A person needs to have the ability to bite off pieces of soft food and chew them until they are ready to swallow
• Avoid foods that are hard, tough, chewy, fibrous, crunchy or stringy

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

Why is this food texture level used for adults?

Level 7 Regular ‘easy to chew’ food may be suitable for people who find hard and/or chewy foods difficult, painful or tiring to chew and swallow. It may be appropriate for people with dental issues, mouth or jaw pain, or those who have been unwell and are recovering their strength.

Who should not have this texture level?

• Those who have an identified increased risk of choking because food pieces can be of any size
• Those who are unsafe to eat without supervision due to chewing and swallowing problems and/or unsafe mealtime behaviours. Examples of unsafe mealtime behaviours include: not chewing very well, putting too much food into the mouth, eating too fast or swallowing large mouthfuls of food
• If the person needs supervision to eat safely, before using this texture level consult a Speech and Language Therapist to determine the person’s food texture needs, and mealtime plan for safety

Guidance on specific food types:

Meat

• Cooked until tender
• If texture cannot be served soft and tender, serve minced and moist

Fish

• Soft enough cooked fish to break into small pieces with the side fork, spoon or chopsticks

Casserole/Stew/Curry

• Can contain meat, fish, vegetables, or combinations of these if final cooked pieces are soft and tender
• Serve in mildly, moderately or extremely thick sauce AND drain excess liquid
• No hard lumps

Fruit

• Soft enough to be cut broken apart into smaller pieces with the side of a fork or spoon. Do not use the fibrous parts of fruit (e.g. the white part of an orange)

Vegetables

• Steam or boil vegetables until tender. Stir fried vegetables may be too firm for this level

Cereal

• Served with texture softened
• Drain excess milk or liquid and/or thicken to recommended thickness level

Bread

• Bread, sandwiches and toast that can be cut or broken apart into smaller pieces with the side of a fork or spoon, which can be recommended following individual assessment from a Speech and Language Therapist

Rice, Couscous, Quinea (and similar food textures)

• No special instructions

All Easy to Chew foods must be soft enough to break apart easily with the side of a fork or spoon and pass Fork Pressure Test.

Foods to avoid:

• Avoid hard or dry food such as nuts, raw vegetables, dry cake, bread and dry cereal
• Avoid tough or fibrous foods such as steak, pineapple and the white of an orange
• Avoid chewy foods such as chewy sweets, cheese chunks, marshmallows, sticky mashed potato, dried fruits and chewing gum
• Avoid crispy foods such as crackling, crispy bacon and cornflakes
• Avoid crunchy food such as raw carrot, raw apple and popcorn
• Avoid sharp or spiky foods such as corn chips and crisps
• Avoid pips or seeds such as pumpkin seeds
• Avoid bones or meat with gristle
• Avoid stringy food such as runner beans and rhubarb

How is food tested to make sure it is Level 7 Regular easy to chew?

Foods should be able to be cut or broken apart with the side of a fork or spoon. They can then be tested using the fork pressure test (see diagram below).

IDDSI Fork Pressure Test - To make sure the food is soft enough, press down on the fork until the thumbnail blanches to white, then lift the fork to see that the food is completely squashed and does not regain its shape.

Suggested regular easy to chew meal ideas

Breakfast

• Egg (scrambled, poached, boiled, fried)
• Soft fruits (skinned) such as chopped banana, ripe peaches, melon, nectarines and strawberries
• Porridge, Ready Brek or instant oat cereal
• Weetabix soaked well in milk with excess milk drained off
• Pancakes with syrup
• Skinless sausages

Main meals

• Well cooked soft pasta and sauce
• Boiled white rice with plenty of thick sauce, for example risotto
• Steamed, poached or baked such as cod, haddock in sauce
• Plain soft omelette with a soft filling
• Minced meat in thick gravy
• Tender meat casseroles and stews with plenty of thick sauce or gravy
•  Lean tender pieces of meat such as chicken or turkey with plenty of thick gravy
• Thick creamy soup
• Fish pie
• Shepherd's pie/Cottage pie/Corned beef hash
• Spaghetti bolognese
• Jacket potato (no skin) with butter, grated cheese, tuna mayonaise or egg mayonaise

Dessert

• Plain sponge cake, cake bars or sponge fingers with custard or cream - no fruit cake
• Steamed plain pudding such as sticky toffee pudding or vanilla sponge with custard or cream
• Soft fruit - fresh or tinned
• Stewed fruit with youhurt, cream or evaporated milk
• Thick and creamy yoghurt or fromage frais
• Creme caramel
• Egg custard
• Rice pudding
• Semolina

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 such as smooth yoghurts, instant hot cereal or weetabix with hot milk, liquidised soft fruit or tinned fruit, fromage frais, mousse and creme 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 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 (PALS)

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 Dept, 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