Safe Swallowing, Easy Eating

Safe Swallowing,
Easy Eating
Information booklet for Patients and Carers
Patient Name
Patient Name:
Date:
You have been advised to take the following:
Food
Normal
Fluids
Normal
Texture B
Thin Purée
Stage 1
Additional Information
Dietitian:
Telephone:
Speech &
Language
Therapist:
Telephone:
Texture C
Thick Purée
Texture D
Moist Mashed / Pre-Mashed
Stage 2
Stage 3
Texture E
Soft/Fork Mashable
Contents
Page number
Introduction
What is dysphagia?
How is it managed?
What happens?
Signs that your swallow might not be working well
4
4
5
5
Who can help?
6
Safe swallowing guidelines
7
Treatment options
8
Dysphagia Food Texture Descriptors
9
What is Texture B/ Thin Purée?
10
What is Texture C/ Thick Purée?
11
What is Texture D/ Moist Mashed / Pre-Mashed?
12
What is Texture E / Soft/Fork Mashable?
13
High Risk Foods
14
Fluid Thickening
15
Guidelines on thickening liquids
How do I use Nutilis Powder?
How do I use Nutilis Clear?
16
17
19
Meeting your nutritional needs
Fluids
Boosting calories in a soft diet
Making foods of your choice soft & smooth
Tips for preparing
Tips for serving and presenting food
21
21
22
23
23
24
Useful equipment
25
Tips for managing dry mouth
26
Tips for managing taste changes
27
Constipation
27
Medications
28
Who pays for these products?
29
Appendix 1: Weight Chart
30
Page 4
Introduction
This booklet is intended to help people who have been told by their Speech and Language
Therapist or Doctor that they have a swallowing problem (dysphagia).
What is dysphagia?
It happens when the muscles of chewing and swallowing (lips, jaw, tongue, palate, throat
muscles) become weakened. This can happen to people with a number of conditions, for
example:
•
•
•
•
•
•
•
•
•
Stroke
Alzheimer's Disease
Multiple Sclerosis
Cerebral Palsy
Head Injury
Parkinson’s Disease
Motor Neurone Disease
Surgery to head & neck
Learning disabilities
How is it managed?
This condition is managed by the Speech & Language Therapist (SLT) and Dietitian. The
Doctors and Nurses are also involved.
Page 5
What happens?
Weakness of the mouth and throat muscles may result in food or drinks “going down
the wrong way”. This means that the food or drinks will go into the lungs instead of the
stomach. This can cause chest infections and pneumonia.
(1) Normal Swallow
(2) Dysphagia
Nose
Mouth
Food/Drink
To
Lungs
To
Stomach
To
Lungs
To
Stomach
Signs that your swallow may not be working well:
•
•
•
•
•
•
•
•
Coughing and choking when you are swallowing food or drink.
Food or drink “going down the wrong way”.
Coughing fits, during or after mealtimes.
Your voice may sound wet and gurgly after eating/drinking.
Food left in the mouth after a meal.
Eating slower than usual, or leaving food on the plate.
Losing weight.
Feeling “chesty” or unwell.
Page 6
Who can help?
Your Speech & Language Therapist will:
• Assess the strength of the muscles in the mouth & throat and your ability
to perform a safe swallow.
• Recommend foods and drinks which are easier to swallow.
• Show you exercises and positions to make swallowing easier and safer, if
relevant.
Your Dietitian will:
• Monitor your weight.
• Recommend the correct food choices to ensure you meet your nutritional
needs.
• Give you advice on fortifying your food.
• If necessary, your Dietitian will recommend appropriate nutritional
supplements e.g. Nutilis Complete Stage 1, Nutilis Complete Stage 2,
Nutilis Fruit Stage 3, Fortisip Compact, Forticreme Complete, Fortijuice or
an alternative nutritional supplement brand.
• It is important that your bowels move regularly. If constipation is a
problem, try the following:
Make sure you are taking enough fluid daily - aim for at least 8 cups of
fluid per day. Your bowel cannot work properly if you are dehydrated.
Page 7
Safe Swallowing Guidelines
Main points
1
2
3
4
5
Fig 1
6
7
8
9
10
Sit upright with arms and shoulders forward, don't rest your arms/
elbows on the table (figure 1).
Remain in the above position for at least 30 minutes after every
meal/drink.
Avoid eating or drinking in a lying down position as it is very difficult
and/or unsafe to swallow in this way.
Never talk while eating or drinking.
Take small amounts at a time, especially of liquids – a teaspoon is
best.
Swallow twice on every mouthful.
If you can hear a gurgly sound to your voice after swallowing, cough
and swallow again.
Avoid foods of a mixed consistency e.g. minestrone soup, fruit and
vegetables with skins such as peas, stringy food such as celery. Please
refer to page 14 for high risk foods to avoid.
Avoid beakers with upright mouth pieces as they cause you to tilt
your head backwards, making it easier for drinks to go down the
wrong way.
Never use a straw for taking drinks.
Note for family/carers:
Do not offer food or fluids to a person with
swallowing problems unless he/she is fully alert.
Page 8
Treatment Options
One way to manage swallowing difficulties is to thicken food and drinks to a consistency considered
safe and appropriate by a Speech & Language Therapist. Thickened food and drinks are easier to
control in the mouth and can be more safely swallowed.
Drinks
Food
Exercise
• You may need your drinks thickened to a safe consistency for
swallowing* (e.g. Stage 1, Stage 2, Stage 3).
• Thickened drinks move slowly in the mouth and throat. This gives you
more time to swallow them safely and easily.
• You may need soft or puréed food which is easier to chew and swallow.
• Certain foods are difficult to swallow. You may have to avoid foods like
brown bread, nuts, crumbly biscuits etc (Please refer to page 14 for high
risk foods to avoid.).
• You may need to do exercises to strengthen the muscles used in biting,
chewing and swallowing food. Your Speech and Language Therapist will
advise you on these if relevant.
Nutilis
* Nutilis Powder and Nutilis Clear are thickening powders
that are added to foods and fluids to thicken them up.
Please see page 16 for more information.
Page 9
Dysphagia Food Texture
Descriptors
What are these descriptors?
These descriptors detail the types and textures of foods needed by individuals who have
dysphagia (swallowing difficulties) and who are at risk of choking or aspiration (food or liquid
going into their airway). The food textures are:
B
C
D
E
= Thin Purée Dysphagia Diet
= Thick Purée Dysphagia Diet
= Moist Mashed / Pre-Mashed Dysphagia Diet
= Soft/Fork Mashable Dysphagia Diet
Your speech and language therapist will tell you which texture diet you should follow.
Page 10
What is a Texture B/
Thin Purée Diet?
Unmodified
Regular
Foods
NAME
Description
Characteristics
Food exclusions
Texture B
Thin Purée
Texture D
Texture C
Moist Mashed
Thick Purée
/ Pre-Mashed
Texture E
Soft/Fork
Mashable
TEXTURE B- THIN PURÉE
• Food has been puréed or has purée texture and does not require chewing.
• It is a thin purée.
• It is smooth throughout with no ‘bits’ (no lumps, fibres, bits of shell/skins,
bits of husk, particles of gristle/bone etc). It may need to be sieved to achieve
this.
• It may have a fine ‘textured’ quality as long as the bolus remains cohesive
in the mouth.
• It is moist.
• Any fluid in or on the food is as thick as the purée itself.
• There are no loose fluids that have separated off.
• The texture is not sticky in the mouth.
• No garnish.
•
•
•
•
•
•
Does not hold its shape on a plate or when scooped.
Cannot be eaten with a fork because it slowly drops through the prongs.
The prongs of a fork do not make a clear pattern on the surface.
Cannot be piped, layered or moulded.
Can be poured.
‘Spreads out’ if spilled. A light, disposable plastic teaspoon must be able
to stand upright.
• If it does not do this, the texture is too thin.
• No hard pieces crust or skin that have formed during cooking/heating,
standing.
Page 11
What is a Texture C/
Thick Purée Diet?
Unmodified
Regular
Foods
NAME
Description
Characteristics
Food exclusions
Sample Foods
Texture B
Thin Purée
Texture D
Texture C
Moist Mashed
Thick Purée
/ Pre-Mashed
Texture E
Soft/Fork
Mashable
TEXTURE C- THICK PURÉE
• Food has been puréed or has purée texture and does not require chewing.
• It is a thick purée.
• It is smooth throughout with no ‘bits’ (no lumps, fibres, bits of shell/skin,
bits of husk, particles of gristle/bone etc.) It may need to be sieved to
achieve this.
• It may have a fine ‘textured’ quality as long as the bolus remains cohesive
in the mouth.
• It is moist.
• Any fluid in or on the food is as thick as the purée itself.
• There are no loose fluids that have separated off.
• The texture is not sticky in the mouth.
• It is not rubbery.
• No garnish.
•
•
•
•
•
Holds its shape on a plate or when scooped.
Can be eaten with a fork because it does not drop through the prongs.
The prongs of a fork make a clear pattern on the surface.
It can be piped, layered or moulded.
Cannot be poured. Does not ’spread out’ if spilled.
• No hard pieces, crust or skin that have formed during cooking / heating /
standing.
• Fluid / gravy / sauce / custard in or on the food has not thinned out or
separated off.
• Breakfast:Thick smooth porridge made from powder (purée porridge) with
no loose fluids. Wheat-biscuit breakfast cereal fully softened with milk fully
absorbed.
• Dessert: Purée rice pudding, mousse with no bits.
Page 12
What is a Texture D/
Moist Mashed / Pre-Mashed Diet?
Unmodified
Regular
Foods
NAME
Description
Texture B
Thin Purée
•
•
•
•
•
•
•
•
•
•
•
•
Characteristics
Food exclusions
•
•
•
•
•
•
•
Sample Foods
•
•
•
Texture D
Texture C
Moist Mashed
Thick Purée
/ Pre-Mashed
Texture E
Soft/Fork
Mashable
TEXTURE D- MOIST MASHED / PRE-MASHED
Food is soft, tender and moist. Needs very little chewing.
It has been mashed up with a fork.
It usually requires a very thick, smooth (non-pouring) sauce, gravy or custard.
No mixed (thick-thin) textures. No loose fluid.
No hard, tough, chewy, fibrous, stringy, dry, crispy, crunchy or crumbly bits.
No pips, seeds, pith/inside skin. No skins or outer shells e.g. on peas, grapes.
No husks, skin, bone or bristle.
No round or long-shaped foods e.g. sausages, grapes, sweets. No hard chunks e.g. pieces
of apple.
No sticky foods e.g. cheese chunks, marshmallows.
No ‘floppy’ foods e.g. lettuce, cucumber, uncooked baby spinach leaves.
No juicy food where juice separates off e.g. water melon.
It holds its shape on a plate or when scooped, cannot be poured and does not ‘spread
out’ if spilled.
Thinner single texture foods maybe suitable if a person is on thinner fluids –SLT to
advise on an individual basis.
No hard pieces, crust or skin that have formed during cooking/ heating/standing.
Check that fluid/gravy/sauce/custard in or on the food has not thinned out or
separated off.
Meat: Must be finely minced-pieces approximately 2mms. No hard bits of mince.
Serve in a very thick, smooth (non-pouring) sauce or gravy.
If it cannot be finely minced, it should be puréed (to texture C)
Fish: Serve finely mashed and in a very thick, smooth (non-pouring) sauce or gravy.
Fruit: Serve mashed. Drain away any juice that has separated.
Casserole/stew/curry: Must be very thick. Can contain meat, fish or vegetable if
prepared as above.
Bread: No bread unless assessed as suitable by a SLT on an individual basis.
Cereal: The texture of very thick smooth porridge with no lumps or the texture of
fully softened wheat-biscuit breakfast cereal with milk fully absorbed.
Desserts: The texture of very thick, smooth yoghurt (no bits) or stewed apple in a
very thick custard. Or the texture of soft sponge cake with smooth filling, fully softened
by mashing and mixing in very thick, smooth (non-pouring) custard.
Page 13
What is a Texture E/
Soft/Fork Mashable Diet?
Unmodified
Regular
Foods
NAME
Description
Characteristics
Food exclusions
Sample Foods
Texture B
Thin Purée
•
•
•
•
•
•
•
•
•
Texture D
Texture C
Moist Mashed
Thick Purée
/ Pre-Mashed
Texture E
Soft/Fork
Mashable
TEXTURE E- SOFT/FORK MASHABLE
Food is soft, tender and moist but needs some chewing.
It can be mashed with a fork.
It sometimes requires a thick, smooth sauce, gravy or custard.
Any fluid, gravy, sauce or custard in or on the food is thick.
No mixed (thick-thin) textures. No thin loose fluid.
No hard, tough, chewy, fibrous, stringy, dry, crispy, crunchy or crumbly bits.
No pips, seeds, pith/inside skin. No skins or outer shells e.g. on peas, grapes.
No husks, skin, bone or bristle.
No round or long-shaped foods e.g. sausages, grapes, sweets. No hard chunks e.g.
pieces of apple.
• No sticky foods e.g. cheese chunks, marshmallows.
• No ‘floppy’ foods e.g. lettuce, cucumber, uncooked baby spinach leaves.
• No juicy food where juice separates off in the mouth e.g. water melon.
• Any fluid, gravy, sauce or custard in or on food must be thick – a light disposable plastic
teaspoon would stand upright.
• Those on Texture E must therefore be able to cope with thinner fluids – stage 2.
• Thinner single texture foods maybe suitable if a person is on thinner fluids –SLT to
advise on an individual basis.
• No hard pieces crust or skins that have formed during cooking/heating/standing.
• Check that Fluid/gravy/sauce/custard in or on the food has not thinned out or separated
off.
• Meat: Pieces of soft tender meat must be served no bigger than 15mms. Or serve
meat finely minced. No hard bits of mince. Serve in a thick smooth sauce or gravy.
• Fish: Soft enough to break up into small pieces with a fork. Serve in thick smooth sauce
or gravy.
• Fruit: Juicy fruit should be mashed – drain away any juice that has separated.
• Casserole/stew/curry: Must be thick. Can contain meat, fish or vegetables if prepared
as above.
• Bread: No bread unless assessed as suitable by SLT on an individual basis.
• Cereal: he texture of thick smooth porridge with no hard lumps. Fully softened
wheat-biscuit breakfast cereal with milk fully absorbed.
• Desserts: Thick smooth yogurt (fork mashable or soft tender pieces of fruit no bigger
than 15mms are acceptable). Stewed apple in thick custard. Soft sponge cake with
smooth filling, fully softened with thick smooth custard.
Page 14
High Risk Foods
Some foods can be particularly difficult to swallow safely. Some will need extra care, others
should be avoided altogether. Your Speech and Language Therapist or Dietitian will advise
you.
Below is a list of types of food that may be difficult to eat:
• Stringy, fibrous texture e.g. pineapple, celery, runner beans, lettuce.
• Vegetable and fruit skins e.g. broad beans, baked beans, soya beans, peas,
grapes.
• Mixed consistency foods e.g. soup with lumps, stewed fruit, mince with
thin gravy, cereals which do not blend with milk (muesli).
• Crunchy foods e.g. toast, flaky pastry, crisps.
• Crumbly items e.g. pie crusts, crumble, dry biscuits.
• Hard foods e.g. boiled and chewy sweets and toffees, nuts and seeds.
• Husks e.g. sweetcorn and granary bread.
NOTE:
No ice cream, ice lollies or jelly unless advised by a speech and
language therapist on an individual basis.
Page 15
Fluid Thickening
As you are experiencing swallowing difficulties your speech and language therapist has
advised thickened fluids to ensure your swallow is as safe as possible. A thickened fluid is
one to which a commercial thickener has been added.
By thickening your fluids, drinking will become easier and safer. If you are in hospital,
thickeners will be provided. At home, they will be prescribed by your GP. Thickeners can be
used in both hot and cold drinks.
The different stages of thickening
Stage 1
This consistency can be drunk through a straw or from a
cup (if advised or preferred). It leaves a thin coat on the
back of a spoon.
Stage 2
This consistency is too thick to drink through a straw, but
can be drunk from a cup. It leaves a thick coat on the back
of a spoon.
Stage 3
This consistency cannot be drunk through a straw, or from
a cup. It needs to be taken with a spoon.
Page 16
Guidelines on
Thickening liquids
The thickener you are using is:
Nutilis Powder
Nutilis Clear
You have been advised to thicken all your fluids to the following consistency:
Stage 1
Stage 2
Stage 3
It is extremely important that ALL fluids or liquid foods are thickened according to the
guidelines below. This includes soup, tea, nutritional supplements and liquid medications.
Mixing Guide for Nutilis Powder
The table below outlines the suggested amount of level scoops of Nutilis Powder required
for different liquids. Please note: the quantity of Nutilis Powder required may vary slightly
depending on the temperature or thickness of the liquid to be thickened.
NUTILIS POWDER SCOOP CHART
200ml Regular fluids
200ml Hot drinks
200ml Milk
Pre-thickened
Supplement
200ml Fortisip
200ml Fortijuce
125ml Fortisip Compact
Stage 1
Syrup
2
3
3
Nutilis Complete
Stage 1
3
5
1
Stage 2
Custard
3
4
4
Nutilis Complete
Stage 2
5
8
2
Stage 3
Pudding
4
5
5
Nutilis Fruit
Stage 3
6*
Nutilis Fruit Stage 3
3*
*Forticreme Complete and Nutilis Fruit Stage 3 can both be used as a Stage 3 nutritional supplement.
Nutilis Powder scoop is 4g.
Alternatively, your Speech and Language Therapist can cross out the table above and complete this table for your specific needs:
Per 200ml fluids
Regular Fluids
Hot drinks
Milk
Supplements:
Stage 1
Syrup
Stage 2
Custard
Stage 3
Pudding
Page 17
How do I use Nutilis Powder?
1 Always use a beaker/shaker for mixing and the scoop provided for
measuring the right amount of thickener.
2 Add Nutilis Powder to 200ml of fluids in the shaker/ beaker. Screw the
lid on tightly.
3 Shake vigorously for approximately 10-20 seconds until all the powder is
dissolved.
4. Remove the lid.
5 Allow to stand for a few minutes until the desired consistency is reached.
Do not add more thickener during this time.
6 Pour and serve.
7 If the drink is too thick after 3-5 minutes, add some liquid to thin it down
to the right consistency.
Note!
•
•
•
•
An average sized cup or glass = 200ml.
An average sized plastic or polystyrene cup = 150ml.
The guidelines set out above apply to Nutilis Powder.
If thickening alcoholic drinks, please ensure that they are thickened to the
recommended consistency or speak to your Speech and Language
Therapist.
• Replace lid securely after each use.
• Use thickener to thicken all liquids, including soup and alcohol.
• REMEMBER to take your thickener with you if you are going on holiday or
eating out.
Additional Tips......
Mixing hot drinks: (temperature > 60°C) Please allow hot drinks to cool for 8 minutes prior to thickening. The use
of the shaker is not recommended for hot drinks. However, if using the shaker for hot drinks, please make sure the lid
is securely tightened, shake lightly and remove the lid immediately after shaking. If desired or needed, drinks may be
heated in the microwave after the addition of Nutilis Powder. If reheating thickened hot drinks please ensure they are
reheated immediately.
Mixing cold drinks: (temperature < 7°C): Allow the cold drink to stand for a few minutes prior to thickening. Let the
prepared liquid stand for a few minutes to achieve the desired thickness.
Mixing carbonated drinks: Please use caution when thickening carbonated drinks, and stir to reduce fizz before mixing
with a fork. The use of a shaker is not recommended for carbonated drinks. If a shaker is used, make sure the lid is
securely tightened, shake lightly and remove the lid immediately after shaking.
Page 18
Mixing Guide for Nutilis Clear
The table below outlines the suggested amount of level scoops
of Nutilis Clear required for different liquids. Please note: the
quantity of Nutilis Clear required may vary slightly depending
on the temperature or thickness of the liquid to be thickened.
NUTILIS CLEAR SCOOP CHART
200ml Drinks
(water, coffee,
tea, juice, milk, etc)
Pre-thickened
Supplement
Stage 1
Syrup
Stage 2
Custard
Stage 3
Pudding
1
2
3
Nutilis Complete
Stage 1
Nutilis Complete
Stage 2
Nutilis Fruit
Stage 3
Nutilis Clear scoop is 3g.
Alternatively, your Speech and Language Therapist can cross out the table above and complete this table for your specific needs:
Per 200ml fluids
Regular Fluids
Hot drinks
Milk
Supplements:
Stage 1
Syrup
Stage 2
Custard
Stage 3
Pudding
Page 19
How do I use Nutilis Clear?
Nutilis Clear can be mixed using a fork, whisk or shaker. The powder may be added to the
glass or shaker before adding the liquid, or you can add the powder after the liquid has been
added to the glass or shaker.
The recommended method is:
Using a fork:
1. Put the required amount of Nutilis Clear into a cup, glass, bowl or shaker
2. Add the drink or liquid to the powder
3. Stir vigorously with a fork for 15-30 seconds
4. Leave to stand for a minute
5. Stir gently for 5 seconds and serve
Using Nutilis Clear correctly will mean that the food and drinks that you thicken will
maintain their flavour, appearance and consistency
Additional Tips......
General tips for usage: Use only the scoop provided in the tin. Add all the powder at once. Start stirring or shaking
as soon as possible. Stir or shake quickly. Stop stirring or shaking as soon as the powder has dissolved, to prevent air
bubbles forming in the drink.
Mixing hot drinks: (temperature > 60°C) Allow the drink to cool slightly before adding Nutilis Clear. If thickening tea
or coffee, always add the milk and sugar to the drink before adding the powder. It is not recommended to use the
shaker when preparing hot drinks, for safety reasons.
Mixing carbonated drinks: For best results, stir carbonated drinks until the drink has gone flat, prior to adding the
powder.
Mixing water: The clarity of thickened water may differ, depending on regional variations in water ‘hardness’.
Page 20
If recommended, Nutritional Supplements
must be your first choice of drink.
REMEMBER:
Which drinks taste best when thickened?
Based on a survey carried out, the following advice is offered;
Juices ✵✵✵✵✵
When thickened, juices taste the same. The thickener does not alter the taste.
Juices are easy to thicken.
Dilutable squashes ✵✵✵✵✵
These taste very nice if made less dilute than usual. Try 1/5 squash, ⁴⁄₅ water.
Both the sugar free and full sugar versions looked and tasted good.
Tea, Coffee ✵✵✵
Tea and coffee tend to need a little more thickener than other drinks. Please
note: Thickener should only be added after the drink has cooled slightly and
any milk or sugar have already been added.
Fizzy drinks ✵
Mixing carbonated drinks including sugar free and diet drinks:
Please use caution when thickening carbonated drinks, and stir to reduce fizz
before shaking.
Water ✵
Water does not look or taste good when thickened.
Milk ✵
Milk has quite a strong flavour once thickened. Try adding flavouring e.g.
chocolate/banana to make a tasty milkshake. Try flavoured milks.
Taste ratings of drinks
✵✵✵✵✵ Excellent! ✵✵✵ OK! ✵ Least Palatable
Page 21
Meeting your nutritional needs
It can be difficult to meet your body’s needs for food and fluids when you
have a swallowing problem. It may take longer for you to finish a meal and
sometimes soft meals are less nutritious than normal meals.
If you have been sick, it is particularly important to make sure you eat and
drink enough every day. This will help prevent any weight loss and help regain
any weight you have lost already.
Here is some advice to make this a little easier:
• Eat “little and often”. Aim for at least two nutritious snacks in between
your meals.
• Try adding extra calories and protein to your food to make it as nourishing
as possible. (See ‘Boosting Calories in a Dysphagia Diet’ page 20).
You may be recommended to take special nutritional supplements by your
Dietitian or Doctor. These may come in the form of a ready-to-drink liquid or
as a powder that is made into a drink.
Pre-thickened nutritional supplements include Nutilis Complete Stage 1,
Nutilis Complete Stage 2 and Nutilis Fruit Stage 3.
Fluids
It is important that you take enough thickened fluids every day. Aim for 8
cups every day. If you are having difficulty managing eight cups per day,
your Speech and Language Therapist or Dietitian may suggest trying prethickened drinks.
Tip! To give variety and prevent boredom, try different temperatures of
fluids in both sweet and savoury flavours.
Page 22
Boosting calories in a dysphagia diet
People who need a dysphagia diet sometimes find it hard to eat all the food that they need.
Here are some tasty tips to help prevent you losing weight. Please check with your
SLT/Dietitian, which of these foods are suitable for your diet.
• Mash vegetables with milk, cream or cream cheese. Try adding some
grated cheese and egg.
• Porridge is a very nutritious breakfast – make with milk rather than water
and add honey or sugar and
• Make up instant soups or gravies with milk instead of water.
• Add cheese and cream to an omelette.
• Dip cooked soft vegetables in dips such as cream cheese, hummus or
sour cream.
• Make instant coffee, hot chocolate or Horlicks (Add Nutilis Powder as
required) with milk and enrich with a spoonful of cream.
• Make milkshakes with Scandishake, add ice-cream, yoghurt and fresh
fruit (Make sure there are no bits/lumps as per your recommended diet
texture).
• Dip your favourite biscuits into tea and coffee.
Make sure you use full fat milk and not skimmed or low fat milk. You could fortify milk
by adding a few tablespoons of dried milk powder to a pint. Use this for drinking and cooking.
Note: If you notice you are losing weight, you should contact your Dietitian or
Doctor who will make recommendations to you to prevent this (see the contact
details at the start of this booklet).
Always take your supplement drinks
as prescribed!
Page 23
Making foods of your choice soft & smooth
Some of your favourite foods can be made soft and smooth using a soaking solution.
Soaking Solution
• 200ml liquid (e.g. milk, fruit juice, stock).
• 1 scoop of Nutilis Powder.
Method
1 Place liquid into a bowl, add Nutilis Powder or an alternative thickener
and whisk thoroughly.
2 Use immediately and do not allow soaking solution to thicken before
adding food.
3 Dip food in soaking solution to thicken for one minute and place on a
plate.
4 Cover and refrigerate for 30 mins before serving.
Serving Suggestions
• Plain biscuits can be made soft and smooth using a fruit juice soaking
solution.
• Sponge cake can be made soft and smooth using a sherry soaking solution.
• Bread can be made soft and smooth using a vegetable stock to make the
soaking solution.
Tips for preparing food
• Everyday foods can be made soft by finely chopping, mashing or mincing.
• Soft foods can be prepared without liquidising, but must be soft enough
to be mashed with a fork.
• A potato masher can be used to remove lumps e.g. potato, fruit,
vegetables.
• A fork can be used to mash soft foods e.g. banana.
• A blender can be used to mince meat and chicken into smaller sized pieces
suitable for a soft diet.
• Vary flavours by adding soy sauce, Worcester sauce, tomato ketchup, curry
powder, herbs and spices to savoury dishes or jam to sweet dishes.
Page 24
Tips for serving and presenting food
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Present each food separately.
Avoid mashing everything together.
If gravy or sauces are required blend, well into food.
Avoid using low calories or low fat liquids to soften food e.g. use milk or
cream instead of water.
• Drain off any excess liquid before serving.
• Serve foods at hot or cold temperatures rather than at room
temperature.
For a copy of the Nutilis Powder Recipe Book please contact your Speech &
Language Therapist or call Nutricia Medical on Freephone 0800 783 4379.
Page 25
Useful Equipment
The following pieces of equipment may help to prepare the
recommended consistency and reduce the amount of time needed to
prepare meals. Many of the items will already be in your kitchen.
Sieve/Strainer is very useful for removing lumps from sauces, gravies,
soups or puréed foods.
Graters are useful for shredding vegetables before cooking.
Whisk & hand-held blenders are useful to mix dry ingredients into
sauces and gravies. They are also useful for adding thickener to drinks,
soups or whipping cream and puréeing small amounts of soft foods.
They are not useful for puréeing hard foods such as cooked meat as
they tend to leave lumps.
Food Processors that chop, grate, mince, shred, slice and whisk are
ideal time-saving devices for preparing food. Food can then be cooked
and/or blended to a smooth and thick texture.
Benchtop blenders are a necessity when preparing most smooth and
thick meals. They are also helpful in producing tasty thickened drinks.
Food Moulds can be used to improve the presentation of modified
meals.
Smoothie makers blend and foam fruit into healthy smoothies.
Plastic beakers (with lids) are very useful for thickening liquids. They
are available from any shop that sells kitchenware.
Nutilis Beakers/Shakers are also available from Nutricia Medical.
Please call 0800 783 4379.
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Tips for managing dry mouth
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Always take fluids or non-alcoholic drinks with meals (thickened to correct
consistency).
Avoid anything that may worsen dryness, such as drinking alcohol and caffinated
drinks, smoking cigarettes and breathing through the mouth.
Sip on juices and other fluids (supplement drinks) throughout the day. Keep fluids
by your bedside.
Replace saliva with salivary substitutes e.g. Glandosane, BioXtra Moisturising Gel.
Stimulate the production of saliva by – Chewing sugar-free gum, rubbing a cotton
bud dipped in lemon juice under the tongue, sucking sugar-free citrus flavoured
sweets/lollipops (Speak with your Speech & Language Therapist before trying these).
Avoid spicy, dry or hard crunchy foods such as biscuits.
Minimise your intake of salty foods as they may cause pain in a dry mouth.
Eat soft creamy foods such as casseroles and soups.
Moisten foods with gravies, sauces, extra oil, margarine, butter, salad dressings,
mayonnaise or yoghurt.
Chew pineapple as it has enzymes that help clean the mouth. Check with your Speech
and Language Therapist that this texture is appropriate.
Protect against dental caries/decay by brushing teeth and gums regularly.
Avoid sticky foods such as toffee.
Keep your mouth very clean (twice daily toothbrushing).
Use fluoride toothpaste.
Use a fluoride, alcohol free mouthwash.
Have regular dental check ups.
If the air in your home feels dry, try using a humidifier or place a pot/bowl of water
near the heat source to help moisten the air. (The humidifier and pot of water should
be cleaned on a regular basis).
Remember...It is important to take your supplement
drinks as prescribed.
Page 27
Tips for managing taste changes
• Use an alcohol free mouthwash regularly.
• Drink plenty of liquids. Thicken as advised.
• Sharp-tasting fruit drinks/juices may help to take away unpleasant
tastes.
• Using strong flavoured sauces can help – curry sauce, chilli sauce or
sweet and sour sauce. Note, strong flavours or spicy foods are not
recommended if you have dry mouth (see page 24).
• Enhance the flavour of foods by using more seasonings and herbs e.g.
oregano, basil, thyme, tarragon, garlic or worcester sauce.
All drinks should be thickened as per
speech and language therapist recommendations.
Constipation
It is important that your bowels move regularly. If constipation is a problem, try the
following:
• Make sure you are taking enough fluid daily – aim for at least 8 cups
of fluid per day. Your bowel cannot work properly if you are dehydrated.
• Take cereal fibre sources e.g. Weetabix, porridge etc.
• Take extra fruit e.g. banana, stewed apple or rhubarb with thickener.
• Include fruit juice e.g. prune or orange, thickened to the correct
consistency.
• Regular exercise to the best of your ability.
Page 28
Medications
Tablets may be switched to a syrup form where appropriate. Some medications may
be crushed and given in food (e.g. yoghurt) but these should be checked with your
pharmacist.
Page 29
Who pays for the food thickener and
nutritional supplements?
Nutilis Powder and Nutilis Clear are available on prescription from your Doctor.
Most nutritional supplements are available on prescription from your Doctor - ask your
Dietitian, Pharmacist or Doctor for further information.
Page 30
Appendix 1
Weight Chart
Please record your weight on a weekly basis.
Weigh yourself in the morning, in your bed clothes & before eating.
DATE
WEIGHT
WEIGHT CHANGE
If you are losing weight please contact your Dietitian or Doctor.
Notes
We wish to acknowledge the input from all members of the
Speech and Language Therapy Department at St.Vincents University Hospital.
For more information Freephone 0800 783 4379