You have been advised to follow a Level 6 soft and bite-sized diet because you have difficulty swallowing.
What is a soft and bite-sized diet?
- Can be eaten with a fork, spoon, or chopsticks
- Can be mashed / broken down with pressure from a fork, spoon, or chopsticks
- A knife is not required to cut the food, but may be used to help load a fork or spoon
- Chewing is required before swallowing
- Soft, tender, and moist throughout, with no separate thin liquid
- ‘Bite-sized’ is described as 1.5cm x 1.5cm pieces: approximate size of an adult thumb nail or the entire width of a standard fork.
Paediatric = 8mm pieces
Adult = 15mm = 1.5cm pieces/3/4 inch
How do I prepare soft and bite sized food?
- Most everyday food can be changed to make them easier to eat
- Food should be cooked well; items are soft and tender, so less chewing is required
- Minimal cutting required and food is easily broken up with a fork or spoon. See lump sizes above.
- Sometimes requires a thick sauce, gravy, or custard. If you are advised to have thickened drinks; any fluid, gravy, sauce, or custard must be the same thickness.
- No bread is advised unless recommended by a Speech and Language Therapist. Additional advice will be added to the leaflet if this is felt safe to include.
Is the texture right?
- No hard pieces, crust or skin formed during cooking/heating
- Ensure gravy, sauce or custard has not thinned or separated off
- Any fluid, (gravy/sauce/custard) on food must be thick. Thinner single texture foods maybe suitable if a person is on thinner fluids – Speech and Language Therapist to advise on an individual basis.
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 foods a thinner consistency. Ensure any fluids are thickened to the correct consistency, as directed by a Speech and Language Therapist.
Fluids
It is important to make sure you drink enough fluid to keep well hydrated. The recommended amount for adults is 1600 – 2000ml daily. If your appetite is poor or you have lost weight, try nourishing drinks:
- Milky tea, milky coffee, hot chocolate, Ovaltine, or Horlicks
- Milkshakes made with fruit or flavoured milkshake powder (blended until smooth, using a hand 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).
- Yoghurt drinks, fruit smoothies, juice, or full sugar squash
- Cup-A-Soup made with full cream milk or double cream
If you have been advised by a Speech and Language Therapist, please ensure you thicken all drinks appropriately.
| Food type | Recommendations |
| Meat, chicken, and meat alternatives | Chewy lumps should be avoided Pieces of soft, moist tender meat must be served as “bite sized pieces” or minced. Serve with a thick smooth sauce or gravy. Remove all skins (e.g., sausage), bones or gristle Casserole/stew/curry must be thick and can contain meat, meat alternatives or vegetables if prepared as above and fully mixed in. |
| Fish | Fish should be soft enough to break up into small pieces with a fork. Serve in thick smooth sauce or gravy. Remove skin and bones |
| Fruit and Vegetables | Fresh fruit should be ripe and peeled Remove pips and skins Cut into “bite sized pieces” or mashed Drain away any juice that has separated Cook vegetables until soft and tender Cut into “bite sized pieces”, adding sauce to moisten May need to puree skin on baked beans/mushy peas |
| Cheese | Grated cheese or very small cubes, cauliflower cheese, macaroni cheese, cottage cheese, cream cheese, crumbled feta cheese and mozzarella cheese (raw cut into chunks). |
| Cereals | Any milk/fluid must be soaked in and not separate from the cereal i.e., no thin loose fluid/no mixed (thick- thin) textures. Overall texture must be thick Porridge, Readybrek or Weetabix fully soaked in milk until soft and the excess milk drained off, especially if you are recommended a thickened fluid by your Speech and Language Therapist. |
| Desserts | Custard, rice pudding, semolina, tapioca, mousse, thick smooth yoghurt with fruity bits. Soft sponges and crumbles can be broken down into “bite sized pieces”, softened with cream or custard if needed. |
| Rice, pasta, noodles | Cook until soft, cut up into smaller pieces and add a thick sauce. No loose, hard pieces of rice or pasta. Rice should not separate into individual grains. |
Foods to Avoid
| BREAD ADVICE— NOT advised unless given as breadcrumbs or blended into soups or milk |
| Dry foods E.g., Crackers, fruit cake, bread |
| Crumbly foods E.g., Hard Biscuits, pie crust |
| Hard foods E.g., Boiled sweets, nuts, crackling pieces or apple or raw carrot |
| Tough or chewy foods E.g., Steak, bacon, harder vegetables |
| Crispy or crunchy foods E.g., Crisps, flaky pastry, crispy bacon, popcorn |
| Stringy or fibrous foods E.g., Pineapple, rhubarb, green beans, celery, melted cheese, steak |
| Pips, seeds, pith/inside skin. No skins/outer shells E.g., grapes, fruit skins/pith or husks (sweetcorn), tomatoes Skins on Peas or beans may be hard and may need to be blended |
| Skin, bone, or gristle E.g., Sausage, chicken, or fish skin |
| Juicy food where the juice separates off in the mouth E.g., Melon, oranges |
| Floppy foods E.g., Lettuce, thinly sliced cucumber, spinach |
| Sticky foods E.g., Some cheese, marshmallows, nut butter (peanut) |
| Mixing solid food with liquid E.g., Hard cereal with milk, fruit salad with juice |
| Chewy foods E.g., lollies/candies/sweets, marshmallows, chewing gum, dried fruit |
Meal ideas –
Bite-sized’ pieces are Paediatric = 8mm pieces
Adult = 15mm = 1.5cm pieces/3/4 inch
Breakfast
- Cereal—Porridge, ready brek or instant oat cereal with full cream milk or double cream. Add sugar, honey, or syrup. Ensure all milk/cream is soaked in. There should be no loose fluids.
- Set yoghurt or fromage frais with fruit (skins removed, chopped into “bite sized pieces” or stewed/pureed)
- Poached, scrambled, or boiled eggs can be cut up into “bite sized pieces” with beans. Please ensure fried eggs are not too crispy. If struggling with bean skins, please blend or mash well.
- Fruit juice—please thicken to the correct consistency if advised to have thickened fluids by your Speech and Language Therapist.
- Tinned Tomatoes with loose fluids removed
- Soft meat or vegetarian sausage (skinless), “bite sized lumps”
- Soft pancake with syrup/stewed fruit/yoghurt, “bite sized pieces”.
- “Bite sized pieces” of bread simmered in milk
Lunch
- Thick soup/broth, lumps should be moist and tender, “bite sized pieces” or blended into the soup. Avoid minestrone/soups with noodles as the fluid tends to be thin and watery.
- Jacket potatoes (do not eat skins) or soft pancakes cut into “bite sized pieces” with: grated cheese, cauliflower cheese, macaroni cheese, cottage cheese, cream cheese, crumbled feta cheese, mozzarella (raw cut into chunks), tuna/salmon/egg mayonnaise, pate/meat paste, blended coronation chicken, hummus, cheese savoury, beans (may need to be mashed well or blended) or spaghetti chopped up.
- Tinned pasta, e.g., ravioli/spaghetti cut into “bite sized pieces”
- Soft quiche with hard pastry removed and mashed or cut into “bite sized pieces”
- Soft omelette cut into “bite sized pieces”.
- Soft scrambled egg with tinned tomatoes (remove all thin liquid)
Main meals
- Flaked fish in cheese sauce/parsley sauce
- Lasagne with hard crust removed, cut into “bite sized pieces”
- Cottage/Shepherd’s Pie with blended mushy peas/beans
- Shredded stewing steak or shredded/minced chicken casserole with meats/vegetables cooked until tender and “bite sized pieces”. If struggling with lumps, blend to the reduce lump size.
- Boiled/mashed potato with double cream/butter and well-cooked vegetables with a thick gravy/sauce (ensure potatoes or vegetables are mashed or “bite sized pieces”).
- Corned beef mashed or cut into “bite sized pieces” or corned beef hash with mashed potato and finely chopped spaghetti.
- Cauliflower or macaroni cheese
- Egg or fish (plaice/salmon/cod/haddock) in hollandaise sauce
- Fish pie with mashed potato topping
- Soft fish cakes (light crumb coating only), ideally with a moist filling with soft or mashed vegetables
- Mince (beef, lamb, pork, turkey), soft dumplings (cut into bite sized pieces) with mashed vegetables and thick gravy.
- Casseroles or hot pot – ensuring meats are shredded or very finely diced, cooked for a long time so everything is very tender.
- Yorkshire pudding, soaked in thick gravy, in “bite sized pieces”.
- Creamy meat, fish, or vegetable risotto (ensure meat pieces are shredded and vegetables are soft, and bite sized soft).
- Risotto with finely chopped or shredded meat and tender “bite sized” vegetables in a thick creamy or tomato sauce.
- Curry and rice with thick sauces rather than dry curries, with finely chopped or shredded meats and “bite sized” vegetables
- Pasta with finely chopped, minced, or shredded meat and tender “bite sized” vegetables in a thick creamy or tomato sauce
- Moussaka ensuring all ingredients are tender and well cooked in “bite sized pieces”.
Puddings /Snacks
- Milk puddings (e.g., rice pudding, semolina, thick custard)
- Instant desserts, whips or blancmange set to a thick consistency
- Fruit compote, Fruit fool, thick yoghurt, fromage frais or mousse
- Puree fruit or bite sized fruit chunks (no skins) with thick custard
- Whipped cream, fromage frais or thick custard with soft cake
- Summer pudding (bread softened in fruit juices, with custard)
- Cheesecake (remove the crumb base or mix in)
- Egg custard, soufflé
No ice-cream or jelly unless advised by your Speech and Language Therapist
References:
The International Dysphagia Diet Standardization Initiative 2016 (http://iddsi.org/framework/)
Contact Us
Nutrition and Dietetics
Nutrition and Dietetic Service
Queen Elizabeth Hospital
Sheriff Hill, Gateshead, NE9 6SX
Speech and Language Therapy
Speech and Language Therapy Service
Queen Elizabeth Hospital
Sheriff Hill, Gateshead, NE9 6SX