1. Holly Froud & Tracy Broadley-Jackson Speech & Language Therapists
Malnutrition & Dysphagia Workshop: Food Texture Descriptors & Equipment
Holly Froud & Tracy Broadley-Jackson
Speech & Language Therapists

2. 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

3. 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

4. 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

5. High risk foods to Avoid: Fork Mashable Diet
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
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

6. 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.

7. High risk foods to Avoid: Pre-mashed Diet
Starchy 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
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
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

8. 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

9. High risk foods to Avoid: Thick Puree
Starchy 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
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
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

10. 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

11. 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

12. 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

13. 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

14. Equipment Dysphagia beaker Dysphagia spoon / teaspoon
Open topped beaker
NOT
Syringe
Straw
Spouted beaker
Tablespoon
(unless advised by SLT)

15. Equipment

16. 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

17. 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.

18. Thank you, any questions?