Advice on safer swallowing Level 6 Soft and bite-sized diet

Name: Date:

Follow us on Twitter @NHSaaa Find us on Facebook at www.facebook.com/nhsaaa Visit our website: www.nhsaaa.net All our publications are available in other formats 2 As you are currently having mild difficulties swallowing, your speech and language therapist recommends that you change the consistency of your slightly. The consistency we recommend for you is:

Level 6 Soft and bite-sized You 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.

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

Advice for specific foods • : 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, or : Must be very thick. Can contain meat, fish or vegetable if chopped to 1.5 cm or thumb nail size and fully mixed in. • : No bread unless your speech and language therapist agrees. • Cereal: The texture of very thick smooth or the texture of fully softened - 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.

4 • 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 with smooth filling. It the sponge is dry it can be softened with thick . 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 crispies (well soaked in milk) • Porridge • Weetabix Lunch and dinner: • soup • (no crusts) with soft filling - for example, tuna , egg mayonnaise (if your speech and language therapist agrees) • scrambled egg

5 • soft omelette • inside of a jacket with tuna, egg mayonnaise or spreading • potato waffles mashed with • tender roast meat in gravy • fish in sauce • fish pie • fish cakes and sauce • tuna mayonnaise • macaroni cheese • spaghetti Bolognese • pasta in sauce • risotto • dishes with rice - when cooking rice, make sure it is soft, well-cooked and mixed with sauce or gravy • corned hash or stovies • casseroled and • (skin removed) • curry and rice • quiche (avoid hard crusts) • shepherd’s pie with gravy • , neeps and tatties

6 • mashed, soft, well-cooked vegetables - must not be ‘stringy’ or ‘woody’. See high risk foods • Desserts: • milk pudding • stewed fruit and custard • • semolina • yoghurts • mousse • Angel delight • with soft fruit • sponge and custard • crème caramel • 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 can be softened with hot drinks, milk or cream.

7 High risk foods Below 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.

8 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 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.

9 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

10 Notes

11 All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice.

Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh.

0800 169 1441 Tell us what you think... If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 28 Lister Street, University Hospital Crosshouse, Crosshouse KA2 0BB. You can also email us at: [email protected]. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response. Name ______Address ______Comment ______

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