Safe and enjoyable mealtimes

easy on the i graphic of man eating and smiling

Non-urgent advice: About eating and drinking

Eating and drinking is an important part of staying healthy. Eating and drinking should also be enjoyable. As well as getting the food and fluid we need to be healthy, mealtimes are an opportunity to spend time with other people. When you eat, food and drink should go into your mouth and down into your stomach. If food or drink goes the wrong way, it can go into the lungs. This can cause a chest infection. Your position when eating and drinking is important. You can watch the posture for eating and drinking video for more information about this. If you have difficulties with eating and drinking it can be harder to enjoy mealtimes, but there are things you can do which can help.

Things to help you have safe and enjoyable mealtimes

  • Think about where you are going to eat. A room that is noisy or busy it will be harder to concentrate on your meal
  • It is best to eat and drink when you are relaxed and comfortable. If you are worried, angry, tired or upset, you won’t enjoy your food and it might make eating and drinking more difficult
  • Some people will not want to drink after eating as they may feel tired or full.
  • It might be better to have a drink first, and then eat your meal
  • Some people may prefer to eat ‘little and often rather than eating big meals
  • It is important to think about what works best for you

If you need help with your eating and drinking

  • If you need help with eating and drinking, the person supporting you needs to understand how you communicate.
  • They need to give you their full attention.
  • This allows them to watch for signs that you are ready for more, and to understand what prompts you might need, such as encouraging you to take smaller mouthfuls or to chew your food well.
  • Positive interactions will make mealtimes more enjoyable
  • It is important not to talk or laugh whilst you have food in your mouth

Non-urgent advice: Top Tips

1.     People’s eating and drinking skills can vary. Some days you may eat and drink well, but on other days you may struggle.

2.     If you are having a bad day, it is important to think about things that will make mealtimes as easy as possible.

3.     Mealtimes are best when everyone is relaxed and comfortable.

4.     Do not rush. Take your time.

5.     Chew food well, and empty your mouth before you have any more.

6.     If you are supporting someone, make sure you know how they communicate.

7.     Follow your eating and drinking guidelines if you have them.

8.     Eat foods you enjoy at the consistency that is easiest for you to manage.

9.     If you need help on making food at the right consistency, ask your Speech and Language Therapist for advice.

10.  Having ‘protected mealtimes’ will mean you are less likely to be interrupted when you are eating.

11.  Smoothies and milkshakes are naturally thick and might be easier to swallow.

Introduction to Mealtime Guidance/Food

Some foods are more difficult to eat than others. Difficult foods are often hard, chewy or crumbly. Here are some tips that might help;

  • Cutting up your food up, or adding sauce or gravy, can make a meal easier to eat.
  • Most people find it easiest to eat food that is soft and moist. This means it needs very little chewing and slips down easily.
  • You may have been advised that your food needs to be modified. If so, you will have been given guidance from your speech and language therapist (SALT)
  • The guidance will tell you if your meals need to be cut up, mashed, or even blended to make it easier to chew and swallow.

You may have been given a mealtime guide

Food that has been modified should still look attractive and taste delicious. When blending a meal, different food items should be blended separately. This keeps flavours separate and the overall appearance will be much nicer. The person making the food should taste it to make sure it is still tasty. Sometimes extra seasoning or flavouring is needed as blended food may taste a bit bland.

You can explore more about food modification in the boxes below.

High Risk Foods: Generic Advice

Some foods are more difficult to chew and swallow.

These are considered to be high risk for people with eating and swallowing difficulties. Some foods may need to be avoided unless they can be modified according to the consistency recommended for the individual.  You can find out more about modification in the Food Modification Level 6,5,4 and 3 guidance below this box.

Here is a list of more challenging textures of foods and some examples of each, but do remember that consideration must always be  always be given to the person’s medical and cultural needs as well as personal preference.

If you are in any doubt about a particular food, or how to modify it, ask your speech and language therapist for more advice.

  • Hard or dry textures: nuts, raw carrots, crackling, hard crusty rolls
  • Fibrous or tough textures : steak, pineapple
  • Chewy textures: candies/lollies/sweets, cheese chunks, marshmallows, chewing gum, sticky mashed potato
  • Crispy textures: crackling, crisp bacon, some dry cereals
  • Crunchy textures : raw carrot, raw apple, popcorn
  • Sharp or spiky textures: dry corn chips
  • Crumbly textures: crumbly dry cakes, dry cookies, dry biscuits or scones
  • Pips, seeds, and the white parts of fruit: apple or pumpkin seeds, the white part of oranges
  • Skins, husks or outer shells: pea shells, grape skin, bran, psyllium
  • Bone or gristle:  includes chicken bones, fish bones
  • Round, or long shaped foods: sausages, grapes
  • Sticky or gummy textures: nut butter, overcooked oatmeal, edible gelatin, candy
  • Stringy textures: green string beans, rhubarb
  • Mixed thin-thick textures: soup with food pieces, cereal pieces with milk, bubble tea
  • Complex food textures: hamburger, hot dog, sandwich, meatballs and spaghetti, pizza
  • Floppy textures: lettuce, thin sliced cucumber, baby spinach leaves
  • Juicy food textures: watermelon

 

Food Modification/Level 6 – Soft and bite sized

Food Modification/Level 6 – Soft and bite sized

Image showing that bite sized for adults is 1.5cm by 1.5cm square or thumb hail sized

  • Food is soft, tender and moist throughout with no separate thin liquid and can be easily mashed with a fork
  • Food is chopped into bite-sized pieces
    5cm (thumbnail size) for an adult / 8mm for a child)
  • Food can be easily squashed between finger and thumb
  • No separate thin liquid
  • No hard pieces of food
  • No ‘High Risk Foods’ unless modified appropriately

Cautions:

  • ALL FOOD SHOULD MEET THE CRITERIA FOR A SOFT AND BITE SIZED DIET:
    Food should be soft, tender and moist throughout with no separate liquid. It should be easily mashed with a fork and chopped into bite-sized pieces (1.5cm or smaller). 

AVOID HIGH RISK FOODS (dry, crumbly foods; stringy, fibrous textures; foods with skins / husks; hard / crunchy foods).

Food modification guidance

Meat Meat should be stewed or slow cooked until soft and tender, then cut to bite sized pieces.
If meat cannot be served soft, tender and bite-sized, it should be shredded or minced. Serve all meat with a thick sauce or gravy.
Stews, casseroles and curry Stews, casseroles and curries can contain meat, fish, vegetables or meat alternatives as long as pieces are soft, tender and bite sized (no hard lumps).

The liquid in stews, casseroles or curries must be thick.

Burgers and sausages Burgers should be freshly made, chopped small and served without bread or garnish. Serve with plenty of thick sauces to moisten (e.g. ketchup, mayonnaise, houmous).

Sausages should be skinless, then shredded/chopped to bitesize pieces.

Fish Remove all skin and bones. Cook until soft and easily broken into small bite-sized pieces (1.5 x 1.5 cm or smaller). Serve in thick sauce.
Avoid hard/crispy batter.
Eggs Scramble, poach or boil. Chop into bite-sized pieces (or mash) and serve with a thick sauce such as hollondaise, mayonnaise, or tomato sauce to moisten.

Avoid fried eggs which can be crispy.

Bread Pre-gelled soaked breads can be prepared using soaking solutions.

No bread unless assessed as suitable by a speech therapist.

If your Speech Therapist has advised you can have bread then prepare with plenty of spread and soft, moist fillings (egg / tuna mayonnaise, cream cheese), remove crusts and present in bite-sized pieces.

Pastry / Pies Only use soft pastry that can be easily mashed with a fork. Add enough gravy / sauce to avoid a claggy texture. Avoid hard crusts.
Pie fillings can contain meat, fish, vegetables or meat alternatives as long as pieces are soft, tender and bite sized (no hard lumps, skins or husks). Moisten with plenty of thick sauce / gravy. If needed, fillings can be minced or blended.
Potatoes Boiled / steamed potatoes should be chopped into small pieces and moistened with thick gravy / sauce. Mashed potatoes should be mashed with enough gravy / sauce / butter / milk until not too sticky. Remove hard edges from chips / roast potatoes and moisten with sauce.
Pasta Pasta should be well cooked until soft and served in thick sauce. Check that pasta shells / ravioli pieces are bite-sized or smaller. Chop spaghetti into bite-sized strips.
Rice Rice can be grainy and sticky. Cook well until very soft, then mash and serve in thick sauce. It should not be sticky or glutinous.
Cereal Opt for soft cereals (e.g. Weetabix, porridge, Ready brek). Soak in warm milk until soft and mushy. Add enough milk to avoid a sticky consistency. Mash to combine. Drain away any excess fluid. Avoid cereals that contain dried fruit.
Vegetables

 

Remove any skins and fibrous parts (e.g. broccoli stalks).

Vegetables should be well cooked (stewed / steamed / boiled) until soft and served in bite-sized pieces. Avoid stringy vegetables (e.g. runner beans, asparagus, celery)

Soups Any lumps in soups should be easily mashed with a fork. Soups containing high risk foods (such as sweetcorn, asparagus, peas) may need to be blended.
Soup should be no thinner than the recommended drinks consistency.
Thicken with fresh soft breadcrumbs, cornflour, or thickener if needed.
Food with husks Avoid vegetables with skins and husks (such as sweetcorn, garden peas, kidney / butter beans and other pulses) unless well blended and then sieved.
Creamed sweetcorn is a good alternative to tinned, frozen or fresh versions.
Fruit

 

Ripened soft fruit (e.g. banana) or soft tinned fruit (e.g. peaches) should be chopped to bite-sized pieces. Thick smooth yoghurt or cream can be used to moisten.

Hard fruits (e.g. apples) should be stewed until soft, then chopped up small or mashed.

For all fruit – remove any stones, skins, pips and hard cores. Drain away any excess thin juice. Avoid dried fruit. Fruit where juice separates when chewed (e.g. watermelon) should only be given if assessed as safe by a speech therapist

An easy way to have fruit is blended into a fruit smoothie or milkshake.

Cake, biscuits, crisps, sweets Opt for soft, light sponges. Serve with thick cream or custard. Avoid dense fruitcakes.

Avoid hard biscuits, crisps and sweets as they are a choking hazard.

Pre-gelled soaked biscuits can be prepared using a soaking solution.

Some people can manage foods that melt in the mouth (Skips, Quavers, Wotsits, Pom Bears). This must be assessed by a speech therapist on an individual basis.

Soft and bite sized meal ideas

Image showing consistency of soft and bite sized food modification

Breakfast ideas

  • Porridge
  • Weetabix
  • Soft fruits (tinned, fresh or stewed)
    in bite-sized pieces served with yoghurt
  • Egg (scrambled, poached, boiled) in bite sized pieces
  • Thick milkshakes or fruit smoothies
  • Skinless sausages in bite sized pieces, with thick sauce

Main meal ideas

  • Thick soup
  • Skinless sausages in bite-
    sized pieces, with thick sauce
  • Very soft chips in bite-sized pieces with thick gravy
  • Tender meat casserole / curry (in bite-sized pieces)
  • Cottage pie (minced meat and mashed potatoes) with thick gravy
  • Steamed/poached fish in sauce, in bite-sized pieces
  • Omelette (with a soft filling such as cheese) in bite-sized pieces
  • Inside of a jacket potato (no skins) with soft fillings (e.g. egg / tuna mayonnaise, cream cheese)
  • Well-cooked, soft pasta in sauce (e.g. macaroni cheese, ravioli), in bite-sized pieces
  • Soft, well cooked vegetables (e.g. carrot, broccoli, sweet potato) in bite-sized pieces

Dessert ideas

  • Rice pudding, semolina
  • Blancmange, Angel Delight
  • Soft fruit (tinned, fresh or stewed) in bite size pieces, served with yoghurt, thick cream or custard
  • Plain sponge cake with cream, in  bite-sized pieces
  • Cake bars with custard or thick cream, in bite-sized pieces
  • Thick, creamy yoghurt / fromage frais
  • Steamed sponge pudding in bite-sized pieces, with thick custard/cream
  • No ice cream for those requiring thickened fluids

Snack ideas

  • Thick milkshakes.
  • Soft fruit (tinned or
    fresh) in bite-sized pieces
  • Smooth yoghurt or fromage frais
  • Smooth guacamole, houmous, taramasalata
  • Smooth fish or meat pate or mousse
  • Plain cream cheese or cottage cheese
  • Cake bars in bite-sized pieces with custard / thick cream
Food Modification/Level 5 – Minced and moist

Food Modification/Level 5 – Minced and moist

  • Food is soft, tender and moist (with no separate thin liquids)
  • Lumps are small (no bigger than 4mm for adults / 2mm    for children)
  • Food needs very little chewing
  • Food can be scooped and shaped on the plate
  • Food is easy to squash with the tongue
  • No lumps bigger than 4mm for adults / 2mm for children
  • No hard pieces of food. No husks, skins or ‘high risk foods’
  • Food does not require a knife for cutting
  • No separate thin liquid
  • Not sticky (food falls easily from a tilted spoon with little food left on spoon)

Tips and cautions:

ALL FOOD SHOULD MEET THE CRITERIA FOR A MINCED & MOIST DIET (FOOD IS SOFT, TENDER AND HAS BEEN MASHED WITH A FORK. LUMPS ARE NO BIGGER THEN 4MM)

AVOID HIGH RISK FOODS (dry, crumbly foods; stringy, fibrous textures; foods with skins / husks; hard / crunchy foods).

  • If food cannot be mashed or finely minced then it should be pureed.

Food modification guidance

Meats Meats should be finely minced or pureed
Mince should be fine (lumps no bigger than 4mm for adults / 2mm for children) and served in thick sauce or gravy. If it cannot be finely minced then it should be pureed.
To puree meats, slow cook until tender then blend with sauce or gravy.
Skinless sausages
can be blended with gravy.
Fish Remove all bones and skin. Cook well (steam, bake, microwave or poach) until soft. Separate soft flaky fish into flakes and mash into thick sauce (cheese/ white/ parsley)
Oily fish can be shredded and finely mashed into a sauce or mashed potato.
Tinned tuna can be mashed with a sauce or mayonnaise.
Eggs Scramble, poach or boil. Mash well with a sauce (warm butter, milk, cream, mayonnaise). Avoid fried eggs, they can be difficult to mash
Bread Avoid bread unless it is a pre-gelled ‘soaked’ bread made with a soaking solution.

 

Pastry and pies Avoid pastry. Soft, tender pie fillings can be blended until smooth. Blend with enough gravy/sauce to avoid a sticky/claggy mix. Pass through a sieve if not smooth.
Potatoes Potatoes can be boiled or mashed with milk/cream/butter. Avoid a sticky texture.

Scooped out baked potatoes (no skins) can be served with minced and moist fillings (mashed tuna/egg mayonnaise, houmous, cream cheese), ensuring the potato is mashed with no large lumps.  Avoid cheddar cheese as this becomes stringy when melted.

Soft ‘chip shop’ chips can be mashed with gravy. Avoid crispy chips/fries/roast potatoes

Pasta
&
rice
Pasta and rice can become sticky and glutinous. Ensure it is cooked well until soft then mash / blend in plenty of sauce until no longer sticky or glutinous.

Risotto rice might be best.

Cereal Opt for soft cereals (porridge, Weetabix, Ready brek). Soak in warm milk until mushy.
Add enough milk to prevent a sticky / claggy texture. Drain away any excess fluid.
Avoid cereals that contain dried fruit.
Vegetables Vegetables should be well cooked (stewed/ steamed/ boiled) until soft. Mash with fluid (warm milk, butter or sauce) to moisten. Drain away any separate thin liquid.
Avoid stringy vegetables (e.g. runner beans, asparagus, celery)
Dense vegetables (courgettes, mushrooms, peppers) will need to be blended.
Soup Soft vegetables in soups can be mashed until lumps are the correct size.
Soups that contain skins/husks (sweetcorn), stringy bits (asparagus, celery) or dense foods (courgette, mushrooms, pasta, meat) should be blended.Sieve if needed to remove skins / stringy bits / husks).
Soup should be no thinner than the recommended drinks consistency
Thicken with fresh soft breadcrumbs, cornflour, or thickener if needed.
Food with Husks Avoid vegetables with skins and husks (such as sweetcorn, garden peas, kidney / butter beans and other pulses) unless well blended and then sieved.
Creamed sweetcorn is a good alternative to tinned, frozen or fresh versions.
Baked beans may be blended and sieved
Fruit An easy way to have fruit is as a fruit smoothie or milkshake.
Ripened soft fresh fruit (e.g. bananas) should be well mashed. Soft tinned fruit (e.g. peaches) mash down better than fresh. Strawberries and raspberries may be mashed with thick cream or yoghurt and sieved to remove seeds.
Hard fruits such as plums, apples and rhubarb should be stewed down to a pulp and well mashed. Rhubarb will need blending as it is stringy.
Remove any stones, skins and pips. Drain away any excess thin juice.
Cake All cakes require additional moistening (e.g. with cream / custard). Fork mash the cake down with enough cream / custard until not sticky and no lumps bigger than 4mm for an adult or 2mm for a child. Avoid dense fruitcakes.
Biscuits, crisps and sweets Avoid regular hard biscuits, crisps and sweets

Pre-gelled soaked biscuits can be prepared using a soaking solution.

Some people can manage foods that melt in the mouth (Skips, Quavers, Wotsits, Pom Bears). This must be assessed by a speech therapist on an individual basis.

Minced and moist meal ideas

image of minced and moist meal

Breakfast ideas

  • Smooth yoghurt
  • Thick fruit smoothies
  • Well-mashed soft banana
  • Eggs (scrambled, poached,
    boiled) mashed well with sauce
  • Stewed fruit mashed with smooth yoghurt
  • Thick porridge or instant oat cereal, add milk so it is not sticky
  • Weetabix – well soaked and mashed in milk

Main meal ideas

  • Thick soup with soft lumps
    (no bigger than 4mm)
  • Flaked fish (e.g. cod) in thick sauce
  • Mashed corned beef served in thick sauce
  • Skinless sausages mashed well in a sauce
  • Shepherd’s pie mashed well with thick gravy
  • Scrambled egg (mashed) or plain well mashed omelette
  • Slow cooked casseroles (meat or vegetables) well mashed. Meats may need to be pureed
  • Tender lean meats mashed or pureed with thick gravy or sauce
  • Well-mashed potato/sweet potato with soft filling e.g. mashed tuna mayonnaise or cream cheese
  • Soft pasta and sauce with soft cheese, well mashed
  • Soft, well cooked and mashed vegetables (e.g. carrots, broccoli, cauliflower, turnip, beetroot)

Dessert ideas

  • Crème caramel
  • Custard / egg custard filling
  • Smooth yogurt or fromage frais
  • Stewed fruit mashed with custard or cream
  • Sponge cake mashed with custard or cream
  • Mousse, angel delight, instant whip, blancmange
  • Soft tinned or fresh fruit, well mashed with excess juice drained away
  • Hot milk puddings e.g. rice pudding, semolina (with seedless jam)
  • No ice cream for those requiring thickened fluids

Snack ideas

  • Thick milkshakes
  • Smooth fruit puree
  • Smooth yoghurt or fromage frais
  • Plain cream cheese or cottage cheese
  • Smooth fish or meat pate or mousse
  • Smooth guacamole, houmous, taramasalata
Food Modification/Level 4 – Puree

Food Modification/Level 4 – Puree

  • Food is smooth (no bits, lumps, fibres, skins, husks etc.)
  • Food is moist
  • Food can be eaten with a fork or spoon
  • Food holds it shape on a plate (it may spread slowly but is not runny)
  • Food can be piped, layered or moulded
  • Food cannot be poured (it is not runny)
  • Food does not need chewing
  • Food has no lumps
  • Food is not sticky (drops from a tilted spoon in one piece without sticking)
  • No separate thin liquid (food is a uniform consistency)

Cautions:

ALL FOOD SHOULD MEET THE CRITERIA FOR A PUREED DIET

  • Avoid ‘High Risk Foods’ (dry, crumbly foods; stringy, fibrous textures; foods with skins/husks; hard / crunchy foods).
  • PLEASE ENSURE ALL FOODS ARE BLENDED TO A SMOOTH CONSISTENCY WITH NO LUMPS.

Food modification guidance

Meats Remove skin, gristle, fat or bones from raw meat. Slow cook until tender, then blend with soup / sauce / gravy until smooth.

Skinless sausages, and meat substitutes (e.g. Quorn, Tofu) can be blended with gravy / sauce until smooth.

Fish Use boneless and skinless fish. Cook well (steam / bake / poach) then blend in a thick sauce (e.g. cheese, white, parsley) to create a smooth texture.
Oily fish can be blended into sauce or pureed potato.
Eggs Eggs do not blend well and may be best avoided. If using, poached eggs blend the best. Blend with milk, melted butter, cream or sauce until smooth. Pass through a sieve to ensure it is smooth.
Bread Avoid Bread unless it is a pre-gelled ‘soaked’ bread made with a soaking solution
Pastry and pies Avoid Pastry
Soft, tender pie fillings can be blended until smooth. Blend with enough gravy/sauce to avoid a sticky/claggy mix. Pass through a sieve if not smooth.
Potatoes Soft boiled potatoes can be blended with warm milk, butter or cream until smooth.

Soft ‘chip shop’ chips can be blended with gravy. Avoid crispy chips / fries.

Pasta & rice Rice and pasta do not blend well (they are bitty and can become claggy). Consider replacing with a potato puree.

If using, risotto rice might be best. Cook until very soft then blend in plenty of fluid (e.g. warm milk, butter, sauce) until smooth and no longer thick, sticky or claggy. Pass through a sieve if not smooth.

Cereal Opt for soft cereals (porridge, Weetabix, Ready brek). Soak in warm milk until soft then blend until smooth. Mix with enough milk to prevent a dry or claggy mix. If needed, pass through a sieve to ensure fully smooth. Discard any loose fluids.

If cereal thickens up over the meal, keep adding milk to maintain the right consistency. Make sure this is well mixed in (no separate thin liquid).

Vegetables Vegetables should be well cooked (stewed, steamed or boiled) or in tinned / creamed form, then blended until smooth. If too thick or sticky, blend with extra fluid (warm milk, cream or stock). Avoid stringy vegetables (e.g. runner beans)

 

Soup Blend soups to a smooth consistency with no lumps.
Soups should be no thinner than the advised drinks consistency; Thicken with cornflour, pureed potatoes or thickening powder as needed.
Food
with
husks
Avoid vegetables with skins and husks (such as sweetcorn, garden peas, beans, pulses) unless passed through a sieve after blending to ensure fully smooth.
Creamed sweetcorn is a good alternative to tinned, frozen or fresh versions.
Fruit Remove all stones, skins and pips.

Fruit smoothie or milkshake. Ensure this is smooth.

Blend ripened soft fruit (e.g. bananas) or soft tinned fruit (e.g. peaches) with enough liquid (milk, cream, custard, fruit juice) to avoid a sticky texture.
Stew hard fruits (e.g. plums, apples, rhubarb) down to a pulp then blend until smooth. Rhubarb may need extra blending as it is stringy.

Pass fruit through a sieve after pureeing to remove seeds / fibres.
Remove any separated thin juice.

Cake All cakes require additional moistening. Blend with cream / custard until smooth and not sticky. Consider a soaking solution for plain sponge cake. Avoid dense fruitcakes
Biscuits, crisps and sweets Avoid biscuits, crisps and sweets
Pre-gelled ‘soaked’ biscuits can be prepared using a soaking solution.

Puree meal ideas

Image of food showing thick puree

Breakfast ideas

  • Stewed fruit blended
    until smooth
  • Thick smooth yoghurts
  • Soft fruits (banana / ripe peach / melon) blended until smooth
  • Milkshakes / fruit smoothies
  • Skinless sausages with tomatoes and baked beans (blended well and sieved to remove skins / seeds / husks)
  • Porridge/ Weetabix/ Ready brek (you may need to keep adding milk to maintain the right consistency throughout the meal)

Main meal ideas

  • Thick, smooth soup
  • Cottage pie blended with
    gravy until smooth
  • Skinless sausages blended in sauce until smooth
  • Tender meat casserole/curry blended until smooth
  • Vegetarian curry or chilli, made with meat substitutes, blended until smooth
  • Steamed/poached fish in sauce blended until smooth, served with pureed potato
  • Soft cooked vegetables and pureed meat, all blended until smooth served with pureed potato
  • Creamed mashed potato, no lumps. Smooth fillings (cream cheese, tuna / egg mayonnaise) can be added for flavour
  • Cauliflower/broccoli in cheese sauce
    blended until smooth

Dessert ideas

  • Blancmange
  • Angel Delight
  • Custard / semolina
  • Sponge cake blended with custard /cream
  • Smooth mousse, yoghurt or fromage frais
  • Steamed sponge pudding with custard
  • Soft fruit (tinned, fresh or stewed) blended until smooth with yoghurt, cream or custard
  • Cheesecake (without a biscuit base or additional topping) blended until smooth with cream
  • Crème caramel blended in custard /cream
  • No ice cream if the person requires thickened fluids

Snack ideas

  • Smooth custard
  • Thick, smooth yoghurt
  • Milkshakes / fruit smoothies
  • Smooth fish or meat pate / mousse
  • Plain cream cheese or cottage cheese
  • Smooth guacamole, houmous, taramasalata
  • Biscuits prepared in a soaking solution*
    (if thickener is prescribed)
  • Sandwiches prepared in a soaking solution* (if thickener is prescribed)

 

 

Food Modification/Level 3 – Liquidised

Food Modification/Level 3 – Liquidised

  • Food is smooth (no lumps, fibres, skins, husks etc.)
  • Food is moist
  • Food can be easily poured
  • Food spreads out on a plate
  • Food cannot be piped, layered or moulded
  • Food does not need chewing
  • Food cannot be eaten with a fork because it drips
    through the prongs (can be eaten with a spoon)
  • Food is not sticky (it should pour from a spoon without sticking)
  • Food has no lumps
  • No separate thin liquid (food is a uniform consistency)

PLEASE ENSURE FOODS ARE LIQUDISED TO A SMOOTH CONSISTENCY – NO LUMPS AND NO SEPARATE, THIN LIQUID

Tips and cautions

  • ALL FOOD SHOULD MEET THE CRITERIA FOR A LIQUIDISED DIET
  • ALL FOOD SHOULD BE SMOOTH AND EASILY POURED
  • AVOID HIGH RISK FOODS (dry, crumbly foods; stringy, fibrous textures; foods with skins / husks; hard / crunchy foods).

Food modification guidance

Meats Remove skin, gristle, fat or bones from raw meat. Slow cook until tender, then liquidise with enough soup / sauce / gravy until smooth and pourable.

Skinless sausages and meat substitutes (e.g. Quorn, tofu) can be blended with gravy / sauce until smooth and pourable.

Fish

 

Use boneless, skinless fish. Cook well (steam, bake, poach) then blend with sufficient sauce (white / cheese / parsley sauce) until smooth and pourable.

Oily fish can be liquidised in sauces until smooth and pourable

Eggs Eggs do not liquidise well and may be best avoided. If using, poached eggs blend the best. Blend with milk, melted butter, cream or sauce until smooth and pourable. Pass through a sieve to ensure it is smooth.
Bread

 

Avoid bread
Pastry and pies Avoid pastry.
Soft, tender pie fillings can be liquidised with gravy / sauce until smooth and pourable. Pass through a sieve if not smooth.
Potatoes Soft boiled potatoes can be liquidised with plenty of warm milk or cream until smooth and pourable

Soft ‘chip shop’ chips can be liquidised with gravy. Avoid crispy chips / fries.

Pasta & rice Rice and pasta do not liquidise well (they are bitty and can become claggy). Consider replacing with a potato puree (liquidised until smooth and pourable)

If using, risotto rice might be best. Cook until very soft then liquidise in plenty of fluid (e.g. warm milk, cream, sauce) until smooth and pourable. Pass through a sieve if not smooth.

Cereal Opt for soft cereals (porridge, Weetabix, Ready brek).

Soak in warm milk until soft, then blend with enough milk until smooth and pourable.  If needed, pass through a sieve to ensure fully smooth. Discard any loose fluids.

If cereal thickens up over the meal, keep adding milk to maintain the right consistency. Make sure this is well mixed in (no separate thin liquid).

Vegetables Vegetables should be well cooked (stewed, steamed or boiled) or in tinned / creamed form, then blended with fluid (melted butter, vegetable juice, cream or stock) until smooth and pourable.

Avoid stringy vegetables (e.g. runner beans)

Soup Liquidise soups to a smooth, pourable consistency with no lumps.

Soups should be no thinner than the recommended drinks consistency; Thicken with cornflour, pureed potatoes or thickening powder as needed.

Food with husks Avoid vegetables with skins/husks (such as sweetcorn, garden peas, beans, pulses) unless very well blended and passed through a sieve until fully smooth.

Creamed sweetcorn is a good alternative to tinned / frozen / fresh versions.

Fruit Remove all stones, skins and pips.

Fruit smoothie or milkshake. Ensure this is smooth.

Blend ripened soft fruit (e.g. bananas) or soft tinned fruit (e.g. peaches) with enough liquid (milk, cream, fruit juice) to create a smooth, pourable consistency.

Stew hard fruits (e.g. plums, apple, rhubarb) down to a pulp then blend with extra liquid until smooth and pourable. Rhubarb may need extra blending as it is stringy.

Pass fruit through a sieve after liquidising to remove seeds/fibres.
Remove any separated thin juice.

Cake

 

All cakes will require additional moistening. Blend with enough cream or custard until smooth and pourable.

Avoid dense fruitcakes.

Biscuits, crisps and sweets

Avoid biscuits, crisps and sweets

Liquidised meal ideas

Image showing consistency of thin puree level 3 of a carrot

Breakfast ideas

  • Smooth yoghurt drinks
  • Milkshakes / fruit smoothies
  • Soft fruits (banana, ripe peach, melon)
    liquidised with juice until smooth and pourable
  • Stewed fruits, liquidised with juice until smooth and pourable
  • Skinless sausages liquidised with sauce until smooth and pourable
  • Porridge / Weetabix liquidised with milk/cream until smooth and pourable

Main meal ideas

  • Smooth soup
  • Tender meat casserole / curry
    liquidised with gravy until smooth and
    pourable
  • Vegetarian curry or chilli, made with meat substitutes, liquidised with stock/sauce until smooth and pourable
  • Cottage pie (separately liquidised minced meat with gravy and potatoes with milk/cream). All a smooth and pourable consistency.
  • Skinless sausages liquidised with sauce/fluid until smooth and pourable, served with potatoes and vegetables, all liquidised with milk/cream until smooth and pourable.
  • Steamed/poached fish liquidised in white/parsley/dill sauce, served with potatoes liquidised in milk/cream. All smooth and pourable.
  • Liquidised potato/sweet potato served with liquidised sides (tuna mayo, cottage cheese, cream cheese)
  • Soft cooked vegetables (e.g. carrot, broccoli, parsnip) liquidised in stock until smooth and pourable
  • Cauliflower or broccoli florets liquidised in a cheese / white sauce until smooth and pourable

Dessert ideas

  • Pourable instant whip
  • Sponge cake, liquidised
    with custard/cream until smooth and pourable
  • Smooth yoghurt drinks
  • Soft fruit (tinned, fresh, or stewed) liquidised with yoghurt, cream or custard until smooth and pourable
  • Rice pudding or semolina liquidised with extra milk/cream until smooth and pourable
  • Crème caramel liquidised with custard / cream until smooth and pourable
  • No ice cream if the person requires thickened fluids

Snack ideas

  • Smooth yoghurt drinks
  • Custard liquidised with milk/cream until smooth and pourable
  • Fruits liquidised with juice until smooth and pourable
  • Smooth guacamole, houmous, taramasalata, liquidised with fluid until smooth and pourable
  • Smooth fish/meat pate, liquidised with milk/cream until smooth and pourable
  • Smooth cream/cottage cheese, liquidised until smooth and pourable
  • Smooth milkshakes / fruit smoothies
Introduction to Mealtime guidance / Drink

Sometimes people can struggle with drinking. Fluid that goes down the wrong way can make you cough and splutter. Here are some tips that might help;

  • Try to keep your head level, rather than tilting it back when you drink.
  • Try drinking slowly and taking single sips, give yourself time to catch your breath before you have another drink.
  • You may be advised to drink a thicker drink. Thick drinks move more slowly than thin drinks and can be easier to control in the mouth.
  • Smoothies and milkshakes are naturally thick and might be easier to swallow.
  • You might be advised to add a thickener to your drink. This would only be suggested following a swallowing assessment. Thickener can be added to any drink, but you must follow the thickening instructions carefully.
  • There are special cups that can help you to drink safely. An Occupational Therapist will be able to offer you advice.
Level 1 – Mildly thick drinks

Levels of thickened fluid Level 1

• Your aim is for the drink to be slightly thick

• Thicker than water

• Requires a little more effort to drink than thin liquids

• Can be drunk through a straw

Level 2 – Slightly thick drinks

Level 2

• Your aim is for the drink to be mildly thick

• It’s sippable

• Pours quickly from a spoon

• Effort is required to drink through standard straw

Level 3 – Moderately thick drinks

Level 3

• Your aim is for the drink to be moderately thick

• Can be drunk from a cup

Level 4 – Extremely thick drinks

Level 4 Your aim is for the drink to be extremely thick

• Can’t be drunk from a cup

• Usually eaten with a spoon

• Can’t be sucked through a straw

• Falls off a spoon in a single spoonful when tilted and continues to hold shape on a plate