You have been advised to follow a Level 4 thick puree diet because you have difficulty swallowing. Pureed foods will be easier for you to manage.
What is a thick pureed diet?
- Usually eaten with a spoon or fork if possible
- Cannot be drunk from a cup or poured
- Does not require chewing
- Can be piped, layered, or moulded
- Falls off spoon in a single spoonful and continues to hold its shape on a plate
- No lumps, not sticky and liquid must not separate from solid
How do I prepare thick pureed food?
- Puree food using a blender or food processor, or mash then sieve. Foods must be a smooth consistency with all lumps removed. It is important that food tastes, looks and smells good.
- Puree the foods separately and put them on the plate separately. This helps to keep the flavour and the colour of the individual foods. Do not puree all foods from the meal together.
- Ensure that all foods are well cooked and moist.
- Remove skins, seeds and cut into small chunks before pureeing
- Puree small quantities at a time to avoid lumps
- Always puree dry foods with extra liquids such as gravy, milk, or stock (try not to use water as this reduces the goodness in the food). Fluid in or on food must match your recommended fluid thickness.
- Thickener, flour, or cornflour may be added to maintain thickness
- Special food moulds and piping bags can be used to make the food look more like the original ingredient.
Is the texture right?
- It does not require chewing
- It is smooth, uniform consistency, no lumps, or bits
- It is moist
- It has no garnish or crusts
- It has no loose fluids
- It is not rubbery or sticky in the mouth
Food fortification for poor appetite or weight loss
If you have a small appetite or have recently experienced unintentional weight loss, it is important to make your food as nourishing as possible. You can do this by adding full fat products to your meals, snacks, puddings, and drinks. This is called food fortification.
| Milk | Add four tablespoons of powdered milk to one pint of full cream milk. Use in drinks, cereal, puddings, sauces, and custard. |
| Cream | Add double cream to mashed potatoes, porridge, cereal, milky puddings, soups, and sauces. |
| Fats | Add margarine or butter to vegetables, potatoes, or pastas. Add mayonnaise or salad cream to potatoes, eggs, cheese, and fish. |
| Cheese | Grate into soups, scrambled eggs, and mashed potatoes. |
| Sugar | Stir into hot drinks, milkshakes, milky puddings, porridge, sprinkle on fruit, and other desserts. |
| Jam / Honey | Add to porridge, puddings, yoghurts etc. |
Please be aware that food fortification may make the foods a thinner consistency.
Ensure any fluids added are thickened to the correct consistency, as directed by your Speech and Language Therapist.
| Food type | Recommendations |
| Meat, chicken, and fish | Meat/ chicken/ fish dishes puree until smooth with extra thick gravy or sauce. |
| Meat alternatives | Pureed baked beans, lentils, or other cooked beans. Pureed tinned refried beans or hummus. Soufflés, mousses, pâté. Pureed scrambled eggs. Puree tofu. |
| Fruit and Vegetables | Pureed or well mashed vegetables with (NO lumps, pulp, or seeds). Stewed or canned fruit that has been pureed Well mashed banana. Fruit packs labelled ‘puree’. |
| Soup/casseroles | Homemade or canned soup/casseroles pureed in a blender. Add blended bread or thickening agent to maintain thicker consistency – should not pour |
| Cereals, pastas, and potatoes | Smooth lump-free cereals e.g., pureed porridge, made from powdered oats. Cereal with milk pureed in a blender (no loose milk). Well cooked pasta, noodles or rice with added sauce pureed until smooth. Puree cooked potatoes |
| Milk and Dairy | Milk, milkshakes, and fruit smoothies. (Thickener in your drinks? please make sure these are thickened to the correct consistency, as direct by your Speech and Language Therapist) Fromage frais or set yoghurt (no lumps), Thick custard and Mousse. Soft and smooth cheese pastes e.g., Smooth ricotta, mascarpone, cream cheese, puree cottage cheese |
Meal ideas
Breakfast
- Porridge or instant ground oat cereal made with full cream milk or double cream. Add sugar, honey, or syrup to taste. Please ensure all milk or cream is soaked in. There should be no loose fluids.
- Set yoghurt or fromage frais (no bits) with pureed fruit
- Pureed scrambled egg with puree beans
- Puree fruit with added whipped cream or set yoghurt or fromage frais.
Lunch
- Thick smooth pureed soup / broth that can be spooned, not drank.
- Cauliflower cheese or macaroni cheese pureed to smooth consistency
- Tinned pasta, e.g., ravioli or spaghetti pureed to smooth consistency
- Pureed potato with puree cottage cheese, puree beans or puree spaghetti
Main meals
- Pureed flaked fish in cheese sauce to a smooth consistency
- Pureed stewing steak or chicken casserole pureed to a smooth consistency
- Pureed potato with double cream and butter, puree vegetables and puree meat or fish
- Pureed smooth vegetables
- Lasagne pureed to a smooth consistency
- Pureed corned beef with pureed potato
Puddings and Snacks
- Puree milk puddings, (e.g., rice puddings, semolina or set custard)
- Instant deserts, whips or blancmange set to a thick consistency
- Fruit fools, smooth set fruit yogurt, fromage frais or mouse.
- Puree fruit with whipped cream or set custard
- Puree oats with full cream milk, set yogurt or whipped cream
- Nourishing drinks – please thicken drinks to consistency advised by your Speech and Language Therapist.
- Smooth peanut butter, soft cream cheese, chocolate spread, smooth jam or marmalade with bread, biscuits or crackers that have been soaked in a soaking solution.
Fluids
It is important to make sure you drink enough fluids to keep you well hydrated. The recommended amount for adults is 1600 -2000mls daily. If your apatite is poor or you have lost weight, try nourishing drinks such as:
- Milky tea or coffee, hot chocolate, Ovaltine, or Horlicks.
- Milkshakes made with fruit or flavoured milkshakes powder
- (Blended until smooth, using a hand-held blender or food processor)
- Complan or Build- Up drinks (can be bought from most pharmacies and some supermarkets and come in a range of sweet or savoury flavours).
- Yogurt drinks
- Cup-A-Soup made with full cream milk or double cream (smooth with no vegetable pieces or croutons).
- Fruit juice or full sugar squash.
If you have been advised by a Speech and Language Therapist, please ensure you thicken all drinks appropriately.
No ice-cream or jelly if you have been recommended thickened fluids by your Speech and Language Therapist.
BREAD is NOT advised unless prepared in a soaking solution or given finely blended into soups or milk.
Soaking Solution: Ingredients
100ml water or stock or fruit juice
1 scoop thickener powder
Preparation
- Pour water or stock or fruit juice into a bowl, add thickener powder and whisk thoroughly
- Place a 1cm thick slice of crust-free bread (no seeds or grains) into the bowl
- Turn bread over after 30 seconds and leave for another 30 seconds
- Place bread on a plate and add a smooth pureed sandwich filling
- Cover and refrigerate for two hours
Plain bread, biscuits, crackers, or cakes (without crusts, seeds, nuts, or grainy parts) can also be prepared in the same way, e.g., using fruit juice as the stock for cake.
References
The International Dysphagia Diet Standardization Initiative 2016 (http://iddsi.org/framework/)