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Advice on safer swallowing

Level 6 Soft and bite-sized diet

Name:

Date:

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As you are currently having mild difficulties swallowing, your speech and language therapist recommends that you change the consistency of your food slightly. The consistency we recommend for you is:

Level 6 Soft and bite-sizedYou should follow these recommendations at all times. Depending on the nature of your difficulties, your speech and language therapist may review these recommendations.

What is a Level 6 Soft and bite-sized diet?• Can be eaten with a fork and spoon.• Can be mashed/broken down with pressure from

a fork or spoon.• A knife is not required to chop this food but may

be used to help loading a fork or spoon.• Chewing is required before swallowing.• Soft, tender and moist throughout but with no

separate thin liquid.• Bite-sized pieces (1.5 cm).

Please note: In hospital this diet is called Level 6 Soft and bite-sized. If you are speaking to any staff- for example, a doctor or nurse- please refer to the diet as Level 6 Soft and bite sized.

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Preparing a Level 6 Soft and bite-sized dietMost foods can be mashed if they are cooked until soft and moist and served with a thick gravy or sauce. The thickness of the food will depend on how much liquid is added.

Advice for specific foods

• Meat: pieces of soft tender meat must be served no bigger than 15mm, or 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 served chopped. Drain away any juice that has separated.

• Casserole, stew or curry: Must be very thick. Can contain meat, fish or vegetable if chopped to 1.5 cm or thumb nail size and fully mixed in.

• Bread: No bread unless your speech and language therapist agrees.

• Cereal: The texture of very thick smooth porridge or the texture of fully softened wheat-biscuit breakfast cereal with milk fully absorbed. Any milk or fluid must not separate off - no loose fluid, no mixed (thick – thin) textures. Overall texture must be thick.

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• Desserts: Desserts should be the texture of thick yoghurt. Any bits should be no bigger than 1.5 cm or thumbnail size and able to be mashed down. They can also be the texture of soft sponge cake with smooth filling. It the sponge is dry it can be softened with thick custard. The overall texture must be thick unless your speech and language therapist has advised otherwise.

• Note: You should not have ice cream or jelly if you need thickened fluids, as these can change to normal thickness in your mouth.

Foods which do not mash well include nuts, peas, sweetcorn, coconut and breakfast cereals.

Examples of appropriate food stuffs:

Breakfast:

• Soft fruit • Cornflakes or rice crispies (well soaked in milk)• Porridge • Weetabix

Lunch and dinner:

• soup • sandwich (no crusts) with soft filling - for example,

tuna mayonnaise, egg mayonnaise (if your speech and language therapist agrees)

• scrambled egg

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• soft omelette • inside of a jacket potato with tuna, egg

mayonnaise or spreading cheese• potato waffles mashed with tomato sauce• tender roast meat in gravy• fish in sauce• fish pie• fish cakes and sauce• tuna mayonnaise• macaroni cheese• spaghetti Bolognese • pasta in sauce• risotto• sweet and sour dishes with rice - when cooking

rice, make sure it is soft, well-cooked and mixed with sauce or gravy

• corned beef hash or stovies • casseroled meats and stews• black pudding (skin removed)• curry and rice • quiche (avoid hard crusts)• shepherd’s pie with gravy• haggis, neeps and tatties

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• mashed, soft, well-cooked vegetables - must not be ‘stringy’ or ‘woody’. See high risk foods

• cauliflower cheese

Desserts:

• milk pudding • stewed fruit and custard • rice pudding • semolina • yoghurts • mousse • Angel delight • trifle with soft fruit • sponge and custard• crème caramel• cheesecake and cream (no base)• jelly• ice cream • soft tinned fruit

Points to remember for you or whoever is making your food:You can make food softer and more moist by adding a sauce or gravy. Harder foods like biscuits can be softened with hot drinks, milk or cream.

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High risk foodsBelow is a list of ‘high risk foods’. These are the foods that are most likely to make you cough and choke and therefore, you should avoid them.

• stringy fibrous textures - for example, pineapple, runner beans or celery

• vegetable and fruit skins, including peas, grapes, baked beans, soya beans, and black eyed beans

• mixed consistencies - for example, cereals which do not blend with milk such as muesli, mince and thin gravy, soup with lumps

• crunchy foods - for example, toast, dry biscuits or crisps.

• crumbly foods - for example, bread crusts, pie crusts, dry biscuits

Swallowing strategies:Here is some general advice which you may find useful. Please note not all of the items will necessarily apply to you. Please concentrate on the ones which your speech and language therapist has ticked specifically for you.

� Sit in an upright position. � Take your time. � Take small mouthfuls. � Try to eat in a quiet place, with few distractions.

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� Only heat up small portions of food at a time so that food does not get cold.

� Smaller, more frequent meals may be less tiring. � Consult your family doctor (GP) or pharmacist

about taking medication in syrup or soluble form.

Do not crush tablets or open up capsules without checking with your pharmacist that it is safe to do this.

Things to avoid:• foods that you find difficult - for many people,

these will be hard, dry or stringy foods. See High risk foods;

• taking very large mouthfuls; • tipping your head back; • eating and drinking when you feel short of breath; • talking while eating and drinking; and • straws unless specifically recommended by your

speech and language therapist.

Please refer to any additional information sheets your speech and language therapist has given you.

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Further Information Please contact the Speech and Language Therapy department if:

• you or your relatives have any worries or questions about your swallowing problem;

• your swallowing deteriorates; or • you develop new swallowing difficulties.

Your Speech and Language Therapy department telephone number is:

Reproduced with kind permission from NHS Greater Glasgow and Clyde

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Notes

Last reviewed: March 2019Leaflet reference: SLT15-007-CCPIL code: PIL19-0025

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