Malnutrition & Dysphagia Workshop:Food Texture Descriptors

& Equipment Holly Froud & Tracy Broadley-Jackson

Speech & Language Therapists

Why do we modify food?

• Easier to eat• Minimise risk• Decrease time & effort & hence fatigue• Optimise swallow safety & efficient movement of

food through mouth & throat to compensate for deficits

• Different textures & consistencies are needed for different problems

• Some eating/swallowing problems may be made worse by giving the wrong texture of food

• Diet modification only works if it happens together with staff & carer training

Food Texture Modification

The Speech and Language Therapist will assess a patient’s swallow and recommend which texture is suitable;

• Normal diet

• Category E Fork Mashable Diet (aka Easy Chew Diet)

• Category D Pre-Mashed Diet (aka Fork Mash Diet)

• Category C Thick Puree Diet

Descriptors listed in red are the National Descriptors

Category E: Fork Mashable Diet

• Soft tender and moist food that can be mashed with a fork

• Pieces of meat no bigger than 15mm or finely minced• Needs some chewing

High risk foods to Avoid: Fork Mashable Diet

Starchy foods•Toast•Oatcakes (all types)•Most biscuits and crackers•Cereals other than those listed•Cereals with dried fruit/nuts•All rice except rice pudding•Pastry/crumbles•Roast potatoes•Jacket potato skins

Dairy•Stringy cheeses such as Mozzarella•Yogurt with nuts or cereal

Fruit & Veg• Unripened or hard fruits• Stringy or segmented

fruit such as oranges or pineapple

• Foods with seeds or pips such as raspberries, strawberries, gooseberries, fresh tomatoes, or jam with seeds

• Stringy or fibrous vegetables such as runner beans, celery, lettuce, raw onions, cabbage and sprouts

• Vegetables and fruit with skins on such as broad beans, sweetcorn, peas, grapes and dried fruit

• BAKED BEANS

Meat, Fish & alternatives• Tough stringy meat such

as spare ribs, bacon or gammon which will not puree smoothly

• Seed and nuts• Pulses (unless sieved)

Other• Crunchy or hard foods

such as crisps, sweets and toffees

• Foods which melt to an unthickened liquid such as ice-cream, jelly or sorbet

• Mixed consistency foods such as soup with lumps, rice pudding with sultanas

Category D: Pre-mashed Diet

• Soft tender and moist foods that are easily mashed with a fork before serving.

• Some variation in texture but meat should be pureed. • Requires little chewing.• Serve mashed foods separately and not all mixed

together.

High risk foods to Avoid: Pre-mashed DietStarchy foods•Toast•Bread•Oatcakes (all types)•Dry biscuits and crackers•Cereals such as Shredded Wheat, All-Bran, Rice Crispies which do not soften sufficiently•Cereals with dried fruit/nuts•All rice except rice pudding•Pastry/crumbles•Roast potatoes•Jacket potato skins•Chips

Dairy•Stringy cheeses such as mozzarella•Yogurt with nuts or cereal or large fruit pieces

Fruit & Veg•Unripened or hard fruits•Stringy or segmented fruit such as oranges or pineapple

•Foods with seeds or pips such as raspberries, strawberries, gooseberries, fresh tomatoes, or jam with seeds

•Stringy or fibrous vegetables such as runner beans, celery, lettuce, raw onions, cabbage and sprouts

•Vegetables and fruit with skins on such as broad beans, sweetcorn, peas, grapes and dried fruit

• BAKED BEANS

Meat, Fish & alternatives• Tough stringy meat such

as spare ribs, bacon or gammon which will not puree smoothly

• Seed and nuts• Pulses (unless sieved)

Other• Crunchy or hard foods

such as crisps, sweets and toffees

• Foods which melt to an unthickened liquid such as ice-cream, jelly or sorbet

• Mixed consistency foods such as soup with lumps, rice pudding with sultanas

Category C: Thick Puree

• Smooth thick puree with no lumps or bits. No chewing required. Can be eaten with a fork or spoon.

• Holds own shape on a plate and can be moulded, layered or piped. Cannot be poured & does not spread out if spilled. Prongs of a fork make a clear pattern on the surface

• No chewing required.• Some foods will require pureeing and sieving

High risk foods to Avoid: Thick PureeStarchy foods•Toast•Bread•Oatcakes (all types)•Dry biscuits and crackers•Cereals such as Weetabix, Shredded Wheat.All-Bran, Rice Crispies which do not soften sufficiently•Cereals with dried fruit/nuts•All rice except rice pudding•Pastry/crumbles•Roast potatoes•Jacket potato skins•Chips

Dairy•Stringy cheeses such as mozzarella•Yogurt with nuts or cereal or large fruit pieces

Fruit & Veg•Unripened or hard fruits•Stringy or segmented fruit such as oranges or pineapple•Foods with seeds or pips such as raspberries, strawberries, gooseberries, fresh tomatoes, or jam with seeds•Stringy or fibrous vegetables such as runner beans, celery, lettuce, raw onions, cabbage and sprouts•Vegetables and fruit with skins on such as broad beans, sweetcorn, peas, grapes and dried fruit

• BAKED BEANS

Meat, Fish & alternatives• Tough stringy meat such

as spare ribs, bacon or gammon which will not puree smoothly

• Seed and nuts• Pulses (unless sieved)

Other• Crunchy or hard foods

such as crisps, sweets and toffees

• Foods which melt to an unthickened liquid such as ice-cream, jelly or sorbet

• Mixed consistency foods such as soup with lumps, rice pudding with sultanas

Snack Ideas – Category E Fork Mashable

• Yogurts (not those containing nuts or cereals)• Soft cake e.g. Swiss roll, cake bars• Soft cheese triangles• Mousse• Fromage frais • Chocolate desserts • Suitable fruit – banana, soft peeled pear, peach, melon• Jaffa cakes• Sponge finger biscuits• Chocolate buttons• ‘Bubbly chocolate’ in small pieces• Small quantity of corn/maize snacks e.g. Skips, Quavers or

Wotsits• Banana and custard

Snack Ideas – Category D: Pre-Mashed Diet

• Yogurts (without lumps of fruit, nuts or cereal)

• Soft mashed cake with cream/custard

• Soft cheese triangles

• Mousse

• Fromage frais

• Chocolate desserts

• Suitable fruit – mashed banana, mashed pear/ peach

• Individual pot of rice pudding

Snack Ideas – Category C: Thick Puree

• Smooth yogurts

• Fromage Frais

• Mousse

• Smooth pureed fruit – may need to be sieved and then thickened

• Smooth instant whip and blancmange

• Smooth chocolate desserts

Fluid consistencies**

Syrup consistency : It is like single cream or runny honey. It moves more slowly in the mouth so is easier to control. It can be drunk from a cup.

Custard consistency: Like pouring custard. This should still be able to run off the spoon. It can be drunk from a cup.

Pudding consistency: A very thick consistency which needs to be given from a spoon. You should be able to stand a spoon up in it.

• Follow the instructions on the back of the thickener tins – clear thickeners require the powder to be put in the cup first before the fluid whereas other thickeners are added to the fluid

• Use a fork, small whisk or a shaker not a spoon• Ice Cream and jelly are not suitable for people on thickened drinks

**Includes all gravy, custard, sauces

Equipment

• Dysphagia beaker• Dysphagia spoon / teaspoon• Open topped beakerNOT• Syringe• Straw• Spouted beaker• Tablespoon(unless advised by SLT)

Equipment

Spouted beakers or not!?

• Disrupts normal drinking pattern

• Requires head to tip backwards

• Person unable to form lip seal

• Difficult to clean (infection control)

• Scalding risk

• Actually increases risk of aspiration

• Difficult for person to predict temperature, amount, flow, taste

Activity

• Get into pairs

• This time one of you is the patient and one of you is the feeder. Each of you will be given an instruction card. Do not show the other person the card. Follow the instructions on the card and then discuss.

Thank you, any questions?