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Managing Your Swallowing Difficulties

Thick Puree Dysphagia Diet (Texture C)

Name: ___________________________________________

DOB: _________________

Date: _________________

Why?You have been advised to eat a Thick Puree Dysphagia Diet – Texture C by your Speech & Language Therapist. This is because one or more of the following:

n You have difficulties chewing solid foods

n There is a risk of choking on solid foods

n Solid foods are more likely to stick in your throat

How?Please see next page ‘How to Prepare Foods for Puree Diet’.

What?Included in this booklet is a table of different foods that are advisable for your swallowing needs.

When?You should continue to follow these recommendations until such a time as a Speech & Language Therapist or Doctor tells you otherwise.

Thick Puree Dysphagia Diet (Texture C)2

Thick Puree Dysphagia Diet (Texture C) 3

Who?If you have any questions/concerns about these recommendations, contact your Speech & Language Therapist:

Name: _____________________________________________

(see back page of leaflet for contact details)

Additional Information (e.g. fluid guidelines, positioning recommendations, medication administration):

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

How To Prepare Foods for a Pureed Diet

What You Will Need

n A food processor, blender stick or blender

n Cooked food

n Sauce/liquid

n Thickening agent e.g. baby rice, corn flour, drinks thickener such as Nutilis or Thick and Easy (available on prescription from GP)

n You may need a sieve for some foods

How to Puree FoodsFood should be pureed to a smooth consistency. The final consistency of the food should be smooth and thick enough to scoop with a fork or spoon; similar to the consistency of mashed potatoes or smooth porridge. Make sure that you puree each component of a meal separately (e.g. vegetables, potato, meat). If you puree them all together the food will look brown and unappetizing.

1. Cook the food (it is much harder to achieve the correct consistency when pureeing cold food). Allow the food to cool down a little.

2. Cut food into small chunks.

3. Put the food in a food processor or blender, or if using a blender stick transfer into a suitable container.

4. Blend until the food is smooth. Make sure you scrape down the sides of the bowl/container while pureeing to incorporate all the ingredients that may become stuck to the side.



5. Examine the texture/consistency of the pureed food. It should be thick enough to hold its shape when spooned on to a plate.

6. If the texture is too dry, add a little sauce/liquid (such as stock, gravy, cream, milk, juice, custard etc) – add a little at a time until the correct consistency has been achieved.

7. If the texture is too runny, add thickener (such as ‘Nutilis’ or ‘Thick and Easy’ which can be prescribed by the doctor), or add baby rice that can be bought from the supermarket. Again, add a little at a time until the correct consistency has been achieved.

8. If there are ‘bits’ left in the food after pureeing, you may need to sieve the puree to remove these bits.

9. If pureeing canned foods, drain the food thoroughly and save the liquid to adjust the consistency during pureeing.

10. Once food is pureed, reheat or cool as necessary before serving.

Dysphagia Diet Food Texture DescriptorsNational Patient Safety Agency (2011)

Thick Puree Dysphagia Diet – Texture C Texture C products must be completely smooth with no lumps.

General description:

pFood has been puréed or has purée texture. It does not require chewing.

p It is a thick purée (see “Thickness of Puree” below)

p

It is smooth throughout with no ‘bits’ (no lumps, fibres, bits of shell/skin, bits of husk, particles of gristle/bone etc.) It may need to be sieved to achieve this.

pIt may have a fine ‘textured’ quality as long as the bolus remains cohesive in the mouth.

p It is moist.

p Any fluid in or on the food is as thick as the purée itself.

X There are no loose fluids that have separated off.X The texture is not sticky in the mouth.X It is not rubbery.

X No garnish.

Check before serving/eating:

XNo hard pieces, crust or skin have formed during cooking/heating/standing.

XFluid/gravy/sauce/custard in or on the food has not thinned out or separated off.



Thickness of Puree:

p Holds its shape on a plate or when scooped.

pCan be eaten with a fork because it does not drop through the prongs.

pThe prongs of a fork make a clear pattern on the surface.

p It can be piped, layered or moulded.

p Cannot be poured. Does not ’spread out’ if spilled.

Breakfasts and Desserts:

pThe texture of thick smooth porridge made from powder (purée porridge) with no loose fluids

pThe texture of wheat-biscuit breakfast cereal fully softened with milk fully absorbed

pThe texture of thick blancmange or mousse with no ‘bits’

p The texture of purée rice pudding

X There are no loose fluids

X There are no lumps

X Wheat-biscuit breakfast cereal has not fully softened

X Milk has not fully absorbed leaving loose fluid

Examples of Foods That Puree Well:

Examples of Foods That Do Not Puree Well:

� Various cooked meats

� Steamed, poached or baked fish or tinned fish (after removal of bones)

� Various cooked vegetables (fresh, frozen or canned)

� Casseroles / stews (i.e. goulash, or any soft casserole)

� Quiche

� Soft pies

� Scrambled Eggs

� Pasta with sauce (i.e. Macaroni cheese, spaghetti bolognaise, tinned pasta)

� Chunky Soups

� Soft pasta salads (e.g. Tuna pasta)

� Baked beans

� Mushy Peas

� Baked/stewed fruit such as apples, pears, rhubarb, apricots (make sure skin is removed before cooking)

� Fresh, Frozen or Canned fruit such as peaches, banana, nectarine, strawberries (make sure skin is removed before pureeing)

� Coarse, gristley pre-prepared meats such as faggots or burgers

� Tough meat

� Sausages with skin left on

� Chewy shellfish such as muscles, clams etc

� Fish skin/bones

� Fried eggs

� Salad vegetables such as lettuce, cucumber, celery

� Vegetables that have a coarse skin/shells/husks such as peas, broad beans, sweet corn etc

� Fruits that are very liquid based such as grapes, oranges, grapefruit, melon

� Stringy/fibrous fruits such as pineapple

� Fruits with lots of little seeds such as raspberries, blackberries etc

� Small fruits which need to be de-stoned such as cherries

� Fruits with skins such as grapes, cherries etc

� Un-stewed dry fruit such as raisins, sultanas, dried apricots etc

� Biscuits, pastry, crisps, sweets, toffees



Examples of Foods That Can Be Used Without ModificationCereals:

� Ready Break �Well soaked Weetabix

Dairy:

� Smooth Yogurt (custard style) � Thick milkshakes �Whipped topping � Custard � Semolina � Angel Delight � Blancmange � Ice Cream*

Fruits:

�Well mashed bananas � Applesauce � Smooth, canned pie fillings (no chunks of fruit)

Vegetables:

�Mashed potato �Mashed sweet potato �Mashed suede �Mashed squash/pumpkin

* Only if able to drink normal/thin fluids.

Soups:

� Smooth, cream soups (i.e. tomato, cream of chicken, cream of mushroom - ensure there are no ‘bits’ NB you may need to sieve the soup to remove any bits before serving)*

Condiments (Other):

� Ketchup �Mayonnaise � Sour cream � BBQ sauce � Honey or thick syrups �Molasses �Mustard � Hollandaise and other

cream based sauces (i.e. Cheese, white, or smooth tomato)

Miscellaneous:

� Refried beans � Jelly*

Thick Puree Dysphagia Diet – Texture C

Recommended Foods Avoid

Bread, cereals, rice, pasta, noodles

� Smooth lump free breakfast cereals e.g. “Readybrek”, semolina

� Pureed pasta or noodles

� Pureed rice

� Cereals with course lumps or fibrous particles such as porridge, all other cereals

Vegetables � Pureed vegetables

� Mashed potato

� Pureed legumes (e.g. baked beans)

� Thick vegetable soups that have been blended or strained to remove lumps

� Coarsely mashed vegetables

� Particles of vegetable fibre or hard skin

Fruit � Pureed fruits (e.g. commercial pureed fruits or pureed fresh fruit)

�Well mashed banana (with no lumps)

� Fruit Juice*

� Fruit Smoothies*

� Pureed fruit with visible lumps

Milk, yoghurt, cheese

� Milk, milkshakes, smoothies*

� Smooth yoghurt with no lumps

� Smooth cheese pastes

� All solid and semi-solid cheese including cottage cheese



Recommended Foods Avoid

Meat, fish, poultry, eggs, nuts

� Pureed meat/fish

� Soufflés and mousses e.g. salmon mousse

� Pureed legumes e.g. hummus

� Pureed scrambled eggs

� Minced or partially pureed meats

� Scrambled eggs that have not been pureed

� Sticky or very cohesive foods such as peanut butter

Desserts � Smooth puddings, dairy deserts, custards, yogurt, mousse, angel delight

� Ice cream*

� Jelly*

�Whipped cream

� Deserts with fruit pieces, seeds, nuts, crumble, pastry or non-pureed garnishes

Miscellaneous � Thin soup without lumps (you may need to sieve soup before serving)*

� Smooth jams, condiments and sauces

� Soup with lumps

� Jams and condiments with seeds, pulps or lumps

* Only if able to drink normal/thin fluids. Fluids must be thickened to recommended consistency if drinking thickened fluids.

Pre-Prepared Foods Suitable for Puree Diet Here are some suggestions of quick and easy snacks that you can find in the supermarket:

n Custard

n Chocolate Mousse

n Smooth Fruit Mousse

n Crème Caramel

n Smooth Fruit Fool

n Fromage Frais

n Smooth Yoghurt

n Pureed Fruit (often found in baby food section)

Ice Cream and Jelly should only be eaten if you are able to drink normal/thin fluids. If it has been recommended that you drink thickened fluids, or water only, these items should not be eaten as they melt/dissolve in the mouth to form a thin liquid.



Menu IdeasBreakfast Ideas

n Porridge, ready brek or oats-so-simple, sweetened with sugar, honey or syrup or pureed soft tinned fruit e.g. prunes/apricots. Cream can be added

n Weetabix made smooth with plenty of milk with Greek yogurt, pureed banana and honey

n Tinned or stewed fruit or soft fresh fruit pureed to make fruit smoothies

n Pureed scrambled egg n Fruit juice*

Snack Meal Ideas

n Pureed cauliflower cheese with sweet potato mash and pureed mushy peas

n Pureed macaroni cheese with pureed carrot and broccoli n Pureed tinned pasta e.g. ravioli in tomato sauce or macaroni cheese

n Smooth soup n The insides of a jacket potato, mashed well with cream until smooth with one of the following fillings:

� Smooth meat or fish paste � Smooth pate � Pureed sardines or pilchards in tomato sauce (take

care to remove small bones) � Cream cheese � Cheese spread � Houmous � Taramasalata � Pureed prawns in seafood sauce � Salmon mousse

In Between Meal Snack Ideas

n Pureed soft, peeled, fresh or tinned fruit e.g. pears, peaches, banana mixed with cream or custard

n Yoghurt fromage frais, mousse, custard or fool n Thick Milkshake* such as McDonalds Milkshake or Frijj from the supermarket*

Main Meal Ideas

n Pureed cottage pie with pureed sprouts and pureed cauliflower

n Pureed shepherd’s pie with pureed carrots and pureed mushy peas

n Pureed chicken casserole with pureed swede, carrot, potato and lentils

n Pureed Dahl with pureed white rice n Pureed tender roast meat in gravy with mashed potatoes, pureed swede and pureed courgette

n Pureed pasta with pureed bolognaise sauce n Pureed lamb Saag with pureed white rice n Pureed chili con carne with pureed white rice n Pureed corned beef hash with pureed baked beans n Pureed mince with gravy, mash potato and pureed soft vegetables

n Pureed chicken curry with pureed white rice n Pureed beef casserole with mashed potato and pureed soft vegetables

n Pureed fish pie, topped with mashed potato with pureed creamed mushrooms and spinach

n Pureed fish poached in milk with white, parsley or cheese sauce, the inside of a jacket potato, pureed mushy peas and pureed swede

n Pureed pasta with pureed tomato or cheese sauce



n Pureed tuna and pasta bake with pureed tinned chopped tomato and melted grated cheese served with pureed ratatouille of vegetables

n Pureed cheese and potato pie with pureed courgette and pureed mushy peas

Desserts

n Pureed tinned or stewed fruit with thick cream/custard n Ground rice pudding n Semolina n Instant whip such as Angel Delight n Smooth fruit fool e.g. gooseberry fool n Crème caramel n Smooth yoghurt or fromage frais n Mousse e.g. chocolate, lemon, strawberry

Puree Ready MealsSome companies produce Thick Puree Dysphagia Diet (Texture C) ready meals that can be delivered to your home and stored in your freezer until you are ready to use them. These meals can be useful to keep in the freezer for times when you do not have time to prepare your meal or if the person that usually prepares your meal is not available.

The following companies offer a range of Thick Puree Dysphagia Diet (Texture C) foods. Contact them to request a brochure or visit their website.

“Wiltshire Farm Foods” (Dysphagia Diet Range)

Tel: 0800 773 773

Website Address: http://www.wiltshirefarmfoods.com

“Simply Puree”

Tel: 0191 456 0456

Website Address: http://www.simplypuree.co.uk/



Meals on WheelsA selection of Thick Puree Dysphagia Diet (Texture C) meals are available from the council run Meals on Wheels services. These services are able to offer both long term and short term contracts (e.g. if the person that normally prepares your food is going on holiday). The meals are made by a company called ‘Apetito’ who also supply Wiltshire Farm Foods (see previous page). The meals are cooked by the council and delivered to you hot on the days requested (this can be 7 days a week or just the occasional day.) These services may work out slightly cheaper than buying the freezable ready meals as described on the previous page.

South Gloucestershire Council Name: Community Meals Service

Tel: 01454 865996

Website Address: http://www.southglos.gov.uk

Bristol City CouncilName: Mobile Meals Service

Tel: 0117 903 1520 or 0117 903 1522

Website Address: http://www.bristol.gov.uk

North Somerset CouncilName: Community Meals on Wheels

Tel: 01275 882 155

Website Address: http://www.n-somerset.gov.uk

Reference:National Patient Safety Agency, “Dysphagia Diet Food Texture Descriptors” (2011)

Dietitians Association of Australia and The Speech Pathology Association of Australia Limited, “Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions”, Nutrition & Dietetics 2007; 64 (Suppl. 2): S53–S76 DOI: 10.1111/j.1747-0080.2007.00153.x

University Hospitals Bristol, Nutrition and Dietetics Patient Leaflet



NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

How to contact us:

Speech and Language Therapy DepartmentCore Clinical Services Directorate

Gate 10Level 6Brunel buildingSouthmead HospitalWestbury-on-TrymBristolBS10 5NB

0117 414 4011

0117 414 4012

© North Bristol NHS Trust. This edition published November 2016. Review due November 2018. NBT002609

Cossham HospitalLodge RoadBristolBS15 1LF

0117 340 8525

www.nbt.nhs.uk

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