Speech and Language Therapy - Swallowing advice for a Soft and Bite Sized Diet (Level 6)

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 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 soft and bite sized diet?

A soft and bite sized diet:

• Should be soft and presented in bite sized pieces (1.5cm x 1.5cm)
• Should require chewing before swallowing
• Should be soft, tender and moist throughout
• Contains no separate thin liquid
• Can be mashed or broken down with pressure from a fork or spoon

Foods NOT suitable for a soft and bite sized 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
• Bread/toast
• Juicy fruit with thin liquid such as watermelon
• Jelly and ice-cream are only suitable when taking normal drinks (no thickener)

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

How is food tested to make sure it is Level 6 soft and bite sized?

Foods that are suitable for a Level 6 soft and bite sized diet can be easily cut with the side of a fork or spoon. It is safest to test foods using the fork pressure test (see diagram below).

IDDSI Fork Pressure Test

When a sample the size of a thumb nail (1.5x1.5 cm) is pressed with a fork to a pressure where the thumb nail blanches to white, the sample squashes, breaks apart, changes shape, and does not return to its original shape when the fork is removed.

Soft and bite sized food must pass both the size and softness tests!

Suggested soft and bite sized meal ideas

Breakfast

• Porridge
• Weetabix soaked in milk
• Hot oat cereal e.g. Ready Brek

Main meals

• Steamed or poached fish in sauce/fish pie/tinned salmon, tuna
• Shepherd's pie/Cottage pie
• Corned beef hash
• Tender meat stews
• Skinless sausages cut into bite sized pieces
• Spaghetti bolognaise
• Rice cooked in thick sauce, for example Risotto
• Mashed potato, sweet potato, swede or avocado
• Soft boiled potato and soft chips in gravy
• Well cooked vegetables - cauliflower cheese, mashed or very soft carrots, turnips, swede, courgette
• Pasta cooked until very soft and cut up in a thick sauce

Snack meals

• Omelettes/poached eggs/scrambled eggs
• Soups - with lentils, potatoes, meat/chicken
• Macaroni cheese
• Jacket potato (no skin) with butter, finely grated cheese, tuna mayonnaise or egg mayonnaise

Bread

• No regular dry bread, sandwiches or toast of any kind
• Pre-gelled 'soaked' breads that are very moist and gelled through the entire thickness. Your Speech and Language Therapist can give you more information on this

Vegetables

• Small, very soft chips in gravy
• Mashed or very soft boiled potatoes
• Mashed parsnip
• Mashed or very soft carrots, turnips, cauliflower, swede, courgette, beetroot etc.
• Mushy peas
• Cauliflower cheese
• Tinned plum tomatoes (no juice)

Fruit

• Banana
• Strawberries
• Skinned: pears, apricots, peaches, plums
• Stewed fruit

All meals must be cut into 1.5cm pieces.

Soft snacks cut into 1.5cm pieces

• Porridge or instant hot cereal e.g. Ready Brek or Weetabix served with hot milk
• Soft fruits or drained tinned fruit e.g. peaches, pears, apricots, mango
• Stewed apple with sugar
• Bitesized (1.5cm) pieces of banana (can be served with custard or cream). Note: if on thickened fluids any liquid will need to be of the correct thickness
• Yoghurt (not muesli type) - thick and creamy varieties, Greek yoghurt
• Fromage frais
• Mousses and crème caramel
• Milk pudding with Jam - home-made, tinned or packet pudding such as custard, semolina, rice pudding and sago are suitable
• Sponge puddings served with cream or custard
• Trifle, milk jelly, blancmange
• Angel delight or instant whip
• Baked egg custard (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 soft snacks cut into 1.5cm pieces)
• 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