: Adult Speech & Language Therapy Service

email: [email protected]
August 2018

Dear Colleague,

What is IDDSI?
International Dysphagia Diet Standardisation Initiative
The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard
with terminology and definitions to describe texture modified foods and thickened fluids
used for individuals with dysphagia of all ages, in all care settings, and for all cultures.
The IDDSI framework consists of a continuum of 8 levels (0-7). Levels are identified by text
labels, numbers, and colour codes to improve safety and identification. The standardised
descriptors and testing methods will allow for consistent production and easy testing of
thickened liquids and texture modified foods.

What does this mean for you?

The speech and language therapists, dietitians and other health professionals across
the UK are in the process of rolling out the IDDSI framework to describe food and drink
recommendations for people with swallowing problems. Roll-out is to be completed by
April 2019.

From April 2018 all clients who are assessed by a speech and language therapist in
both the hospital and community settings including care homes, will have
recommendations in line with the IDDSI framework.

All your staff will need to be familiar with and understand the framework including your
chefs and cooks.

Clients on existing food and drink recommendations will not need to be

reassessed. Continue to follow current recommendations unless you have specific
concerns. You will be able to use the IDDSI framework enclosed to map them
across.
 The manufacturers of thickening products for drinks are also changing their products to
be IDDSI compliant by April 2019. You will see changes to the labels on the
products and the scoops. Companies who make modified diets, such as pureed
meals are also changing their recipes and products to be IDDSI compliant by April 2019.
Many of the manufacturers such as Nutricia who make Nutilis Clear are offering training
on the IDDSI framework.

If you are using several thickeners you will need to refer to the tin or contact the
manufacturers directly for further advice. Information on the changes to Nutilis clear is
included.

What do I do now?
Learn more about the IDDSI framework using the links below.
https://youtube/Zd6prmzm39k
This is a really great 10 minute YouTube clip which gives a really clear overview of the
IDDSI framework in the UK.

www.iddsi.org.
This includes background information, training resources, frequently asked questions,
posters and leaflets. You can sign up their newsletter.

www.nutriciahcp.com/adult/Studies/Dysphagia_Learning_Module/
This is an e-learning package written by Nutricia that takes approximately 20-25minutes

Useful documents
http://iddsi.org/Documents/IDDSIFramework-CompleteFramework.pdf/
Complete IDDSI framework & detailed definitions/descriptors

http://iddsi.org/Documents/IDDSIFramework-TestingMethods.pdf/
https://www.youtube.com/watch?v=BhfJWu1ybbs&index=1&list=PLa8-
lAnKo0KYX524EQbTM3thWS9G2SCC6
Liquid testing methods & videos for testing drinks and food – particularly relevant for
your catering staff

There is more information and ideas on implementation, making and testing food and
drinks on the IDDSI YouTube channel and App.
https://www.youtube.com/channel/UC0I9FDjwJR0L5svIGCvIqHA/videos/
Search “IDDSI” on your App store.
You might like to consider having an IDDSI Champion to help with spreading the word on
IDDSI in your setting. You could talk to colleagues in other homes about organising some
joint training and shared learning.

Kind Regards

Adult Speech & Language Therapy Service, Local Partnerships, Nottinghamshire

Healthcare Foundation Trust
Enclosed:
Poster to display in your kitchens and care home, Are you IDDSI Ready?
Dysphagia leaflet
Thickening fluids
Nutilis Clear changes
Diet leaflets – Liquidised, Pureed, Minced & Moist, Soft & Bite Sized

The International Dysphagia Diet Standardisation Initiative 2016 @http://iddsi.org/framework/.

Attribution is NOT PERMITTED for derivative works incorporating any alterations to the IDDSI Framework
that extend beyond language translation. Supplementary Notice: Modification of the diagrams or
descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to
elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for
patients with dysphagia. Such errors have previously been associated with adverse events including
choking and death.
 ARE YOU IDDSI READY?
The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global
standard to describe texture modified foods and thickened drinks for individuals with
swallowing difficulties of all ages, in all care settings.
The IDDSI framework consists of a continuum of 8 levels (0-7). Levels are identified
by labels, numbers and colour codes to improve safety and identification. The
standardised descriptors allow for consistent production and testing of thickened
drinks and texture modified foods.
We will be rolling out the IDDSI framework from April 2018. Look out for the IDDSI
terminology on the products you use for thickening drinks and modified foods.
E.g. The Clear scoop size and colour is changing from a purple 3g
scoop to a green 1.25g scoop to be IDDSI compliant.

formally NORMAL Diet

formally FORK-MASHABLE
formally MASHED/PRE-MASHED

formally PUDDING/ stage 3

formally CUSTARD/STAGE 2

formally SYRUP/STAGE 1

formally NORMAL fluid

More information is available on the IDDSI website

www.iddsi.org
The International Dysphagia Diet Standardisation Initiative 2016 @http://iddsi.org/framework/. Attribution is NOT PERMITTED for
derivative works incorporating any alterations to the IDDSI Framework that extend beyond language translation. Supplementary Notice:
Modification of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to
elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such
errors have previously been associated with adverse events including choking and death.
 Dysphagia
Adult Speech and Language Therapy Department
County Health Partnerships
WhatisisDysphagia?
What Dysphagia? Problems
Problems toto look
look outout
for for
whenwhen
eating
• Dysphagia means a difficulty swallowing
• Dysphagia means a difficulty with swallowing. and drinking
eating & drinking
• Many
• Many people havehave
people Dysphagia,
Dysphagia,which whichcancan
be caused
be • Difficulties with chewing and keeping food or
• Difficulties with chewing and keeping food or drink
by neurological damage following
caused by neurological damagestroke, head
following: drink in your mouth
in your mouth.
injury, brainhead
stroke, tumour, motor
injury, brainneurone
tumour, motor disease,neurone • • Sensation of food going down the wrong
Sensation of food going down the wrongway,
way,or
or
multiple sclerosis,
disease, dementia
multiple sclerosis, dementia. something ‘sticking’, pain or discomfort
something ‘sticking’, pain or discomfort.
• It may be caused by structural damage following:
It• may be caused by structural damage • • Coughing
Coughing during
during or after
or after food
food or or drinks.
drinks
oral cancer,
following throat throat
oral cancer, cancer,cancer,
tracheostomy etc.
tracheostomy • Voice may sound wet/gurgly after drinking.
• Dysphagia • Voice may sound wet/gurgly after drinking
• Dysphagia is aiscomplex
a complexcondition.
condition. ItItcan
canvary in severity.
vary in • Feeling short of breath, during or after food or drinks.
• Instrumental and radiological
severity • • Feeling short
Feeling of breath,
‘chesty’, during/after
during or after foodfood or drinks
or drinks.
techniques(VF/VPG+FEES) may bneused to assess
• Instrumental and radiological techniques If• you notice
Feeling any of during/after
‘chesty’, the above, please
fooddiscuss with the
or drinks
swallowing function.
(VF/VPG+FEES) may be used to assess swallowing nurse or doctor.
• For people with severe swallowing difficulties, there
function Some
are alternatives to eating and drinking orally e.g. Some guidelines
guidelinesto
tomake
makeswallowing
swallowingeasier
easier
• For people with tube.
nasogastric severeThisswallowing difficulties,
can be discussed with your • Discuss the best sitting position with your speech
theredoctor
are alternatives to eating and drinking orally • Discuss the
& language best sitting position with your speech &
therapist
and dietitian.
e.g. nasogastric tube. This can be discussed with language therapist.
• Allow plenty
• Allow of time
plenty and
of time trytry
and totorelax
relax.
your doctor and dietician
Lips (closed) • • Take
Take smallsmall mouthfuls
mouthfuls of food
of food and and drink.
drink
The Dysphagia Team • • Always
Always chewchew
food food thoroughly.
thoroughly
Tongue Tongue
• Avoid mixing food and drink in the same mouthful.
• Nursing staff, doctors • Avoid mixing food and drink in the same mouthful
and speech and • Colder drinks may be easier than hot.
language therapists are • Colder drinks
• Thicker may may
drinks be easier thanthan
be easier hot thin.
often the first people to Lungs Food
• • Do not
Thicker usemay
drinks spouts
be or straws
easier when
than thindrinking, unless
The Dysphagia
identify swallowing Team advised to by a speech & language therapist.
difficulties • Do
• not
Takeuse spouts
advice fromor straws
speech when drinking,
& language unless
therapy regarding
• Nursing staff, doctors and speech and language advised to by a speech & language therapist
Lips compensation techniques for swallowing rehabilitation.
therapists speech
• The specialist are often
& the(closed)
first people to identify
language therapist
swallowing will
difficulties. • Take
Afteradvice from speech & language therapy
mealtimes
provide
• Thea specialist
full assessment
speech & language therapist
Lungs Foodwill regarding compensation techniques for swallowing
• Do not lie down for 30 minutes after a meal.
rehabilitation
provide a full assessment. • Check there is no food left in your mouth.
 After mealtimes
Other Useful Things to Know
• Do not lie down for 30 minutes after your meal
• there
• Check If swallowing tablets
is no food is difficult,
left in your mouth some can
be obtained in different forms e.g. syrup.
Contact the pharmacist for details.
Other Useful Things to Know
• Equipment is available to make eating and
• If swallowing tablets is difficult, some can be
drinking easier; e.g. specially designed
obtained in different forms e.g. syrup. Contact
cutlery, cups, plates and non-slip mats.
the pharmacist for details
Contact your occupational therapist
• Equipment is available to make eating and
for details.
drinking easier; e.g. specially designed cutlery,
• If dentures are loose, swallowing may be
cups, plates and non-slip mats. Contact your
more difficult.
occupational therapistContact your dentist who may
for details
be able to alter them to fit more comfortably.
• If dentures are loose, swallowing may be more
difficult. Contact your dentist who may be able
to alter them to fit more comfortably

Speech & Language You have been referred to:

Therapy Department
Nottingham:
Contact:
0115 9709221 (direct line) You have been referred to:
Speech and Language
or
Therapy Deppartment,
Mansfield/Newark:
Nottingham University
01623Hospitals NHSTrust,
622515 ext 3320
City Hospital Campus,
Tel 0115 969 1169
ext 55350

March 2015 – NH384

SIGNS TO LOOK OUT FOR:
Coughing or choking on food or drink.
Name: Date:
A gurgly or bubbly voice after eating and drinking.
Speech and Language Therapist:
Feeling or sounding “chesty”.
Shortness of breath during or after eating or drinking. THICKENING DRINKS
If you are having any of these problems, please contact
your GP and Speech and Language Therapist
immediately. Thicker than water. Requires a little more effort to drink
than thin liquids. Flows through a straw.
For more information regarding the International
Dysphagia Diet Standardisation Initiative (IDDSI) and the
flow test, please refer to http://iddsi.org/
Flows off a spoon. Sippable, pours quickly from a spoon,
Speech and Language Therapy Departments: but slower than thin drinks. Effort is required to drink this
thickness through a standard straw.
Stapleford Care Centre (0115) 8760117
Queens Medical Centre (0115) 9709221
Kings Mill Hospital & Newark (01623) 622515 ext 3320
Can be drunk from a cup. Some effort is required to suck
Mansfield Community Hospital (01623) 785166 through a standard or wide straw.
Key points to remember:
Cannot be drunk from a cup. Cannot be sucked through
a straw. Falls off spoon in a single spoonful when tilted
and continues to hold shape on a plate.
WHY THICKEN DRINKS? HOW DO I USE THICKENER?
Some people with swallowing difficulties may find it easier and safer 1) Put the specified amount of thickener into the drink.
to have their drinks thickened. Thicker drinks move more slowly and 2) Immediately and gently stir the mixture with a spoon, fork or
are therefore easier to control in the mouth and throat. If you have a whisk until all the powder has dissolved.
swallowing problem, thin drinks may go down the wrong way and 3) Leave to stand for up to 5 minutes to thicken and stir again.
could cause a chest infection.
4) Check the consistency is correct and that there are no lumps. If
the correct consistency is not achieved you must start again.
WHAT IS THICKENER?
Thickener is a powder which can be added to all fluids, including TIPS FOR THICKENING:
soups, sauces, liquidised food, alcohol and fluids poured over
cereal. It does not add any nutritional value. Some people find thickened tea and water less enjoyable than
other stronger flavoured drinks such as squash and hot
chocolate.
HOW WILL I GET THICKENER?
Always add the milk and sugar to hot drinks first. Allow the drink
Your thickener will be prescribed by your GP.
to cool slightly before adding the thickener.
For best results stir fizzy drinks until the drink has gone flat,
HOW MUCH THICKENER DO I NEED? before adding the thickener.
People need their drinks thickened to different consistencies in order Milk based drinks often take longer to thicken.
to be safe. We call these consistencies ‘slightly thick, ‘mildly thick’,
Some drinks are naturally thicker e.g. milkshakes, yoghurt drinks,
‘moderately thick’ and ‘extremely thick’. Each tin comes with its own smoothies, tomato juice and so might not need much thickener.
scoop and guidelines for how much to add to achieve these It is advised that you do not thicken nutritional supplements.
consistencies. You can check your drink meets the standardised Please speak with your GP or Dietitian as pre-thickened
supplements are available.
recommendations by using the IDDSI Flow Test, see the link
detailed on the back of this leaflet.
 Clear Thickener
NEW SCOOP AND MIXING INSTRUCTIONS
The International Dysphagia Diet Standardisation Initiative (IDDSI) framework
for describing texture modified food and drink is being adopted across
Nottingham and Nottinghamshire from April 2018.
In order to align with this change, the scoops in the tins of Nutilis Clear will be
changing from a purple 3g scoop to a green 1.25g scoop and the directions
for use on the label of Nutilis Clear will be different. These new tins will be
easily identifiable due to a red information sticker on the tin lid.
Previous Directions for use: New Directions for use:
UK National Descriptors IDDSI Framework
Old purple New GREEN
scoop
No. of scoop
Previous No. of
Stages per
scoops New Levels
200ml per 200ml scoops

N/A N/A Slightly thick 1 (1.25g)

Syrup (Stage
1 (3g) Mildly thick 2 (2.5g)
1)

Custard (Stage 1.5 Moderately

2) (4.5g) 3 (3.75g)
thick
Pudding
3 (9g) Extremely thick 7 (8.75g)
(Stage 3)

This change affects the number of scoops required to thicken drinks. As

a result the thickness of drinks will be different. If in doubt, check the tin
instructions. If you still need help or support seek advice from speech
and language therapists, dietitians, pharmacists or your nurse.

For any general queries on this change, please contact the Nutricia Resource Centre:
UK - 01225 751098 or [email protected]

Nutilis Clear is a Food for Special Medical Purposes for the dietary management of dysphagia and must be used under
medical supervision. This information is intended for Healthcare Professionals only.
 Soft and
Bite Sized

The information in this booklet is for:

This booklet has been given by:

Contact number:

Date:
It has been recommended that
you have a Soft & Bite Sized diet
to make it easier and safer to eat.

You can still eat and drink many of the foods and fluids you enjoy,
although the consistency may need to be altered.

The speech and language therapist may have advised you to alter the
consistency of your food and drink. It is important that you follow this
advice in order to remain fit and well. Following the advice will help to
reduce the distress of coughing at mealtimes and the risk of developing
chest infections.

The speech and language therapist will also advise you on the best way
to eat and drink, for example when sat upright and when most alert.

The dietitian can advise

on ways to ensure your
soft & bite sized diet The diet consistency
is well balanced and you have been recommended
nutritious. is Soft & Bite Sized
The fluid consistency you have
Please read this leaflet
been recommended is
in conjunction with
your personalised
recommendations.

IDDSI 6 [previously known cat E, as mashable, soft chopped]

What is a Soft & Bite Sized diet?
Soft & bite sized food that is ordinary food that...
• Can be eaten with a fork, spoon or chopsticks.
• Can be mashed/ broken down with pressure from fork, spoon or
chopsticks.
• A knife is not needed to cut this food, but may be used to help
load a fork or spoon.
• Needs chewing before swallowing.
• Soft, tender and moist throughout but with no separate thin liquid
i.e. no runny sauce containing lumps or bits, e.g. minestrone soup,
muesli, Rice Krispies©, cornflakes© etc
• Presented in ‘bite sized’ pieces as appropriate for size and chewing
ability i.e. no bigger than 0.8cm for children and 1.5cm for adults
or the size of your thumb nail
How will I know that I have the right texture?
Fork & spoon pressure: Chopsticks
Pressure from a fork or spoon Chopsticks can be used to break
held on its side can be used to this texture into smaller pieces
‘cut’ or break this texture into
smaller pieces. When a piece Fingers
of food the size of a thumb It is possible to hold a piece of
nail (1.5x1.5 cm) is pressed soft food the size of the thumb
[with the base of a fork or nail (1.5 cm x 1.5 cm). It is
bowl of a spoon] using enough possible to squash it using finger
pressure to make the thumb pressure such that the thumb
nail blanch white, the piece of and index finger nails blanch to
food squashes and changes white. The piece of soft food
shape, and does not return to will not return to its initial shape
its original shape when the fork once pressure is released.
or spoon is removed. Please
note, this is not how it should be
presented, it’s a test of softness.

Pressure causing the

thumb nail to blanch
white & squash the food.

The food will not return

to its original shape
when the fork is removed.

20 mm
How do I make the food I like into a Soft &
Bite Sized consistency?
There are many “ordinary” foods that are already the correct
consistency whilst others will need adapting. Think about the food
you would usually eat and use the guidance in this booklet to help
you to achieve the correct texture where necessary.

What equipment will I need?

Many foods can be softened with sufficient cooking and cut to bite
size pieces with a knife or fork. However some foods may need to
be mashed. A potato masher may be useful and an electric hand
blender. Remember that not all foods will need mashing or
blending and you don’t need to blend until the food
is smooth.
How do I prepare a Soft & Bite sized?

Please be aware that these Fish

are guidelines only. How Poach or steam fish until it is
you cook the food i.e. soft enough to break into small
temperature and duration, pieces with a fork, spoon or
can significantly change the chopsticks [remember to remove
all the bones].
consistency and texture of
the finished item. Casserole / stew / curry
dishes
Meat & meat substitute
Can contain meat, fish or
Tenderised & cooked meat pieces
vegetables if final cooked pieces
should be no bigger than 1.5 x
are no larger than 1.5 cm x 1.5
1.5cm [no gristle or skin]. If the
cm and are soft and tender. There
soft and tender texture cannot be
should be no hard lumps & the
achieved at 1.5 x 1.5cm pieces
liquid portion must be thick.
then cook and serve ‘minced &
moist’ [2mm – 4mm] pieces with Eggs
a thick, non-pouring gravy softly scrambled egg, egg
or sauce. custard, boiled eggs that
have been well mashed with
mayonnaise or other thick sauce,
lightly cooked omelette.
Examples of liquids that
can be used to cook / Fruit
tenderise the meat and Fresh or cooked fruit can be
fish are gravy, stock, included, however cooked fruits
homemade or readymade may be easier to prepare safely.
sauces. The liquid can Remove the skins, mince / mash
be thickened with flour, the fruit and drain any excess
corn flour or prescribed fluid before eating. Be cautious
thickeners before serving. with fruit with small seeds
or pips.
Vegetables and potato soaked in soups or sauces.
Remove the skins and steam or Crusts must be removed.
boil vegetables until they are Bread should not be eaten
soft. The final cooked size should in any other way unless
not be larger than 1.5 cm x your speech and language
1.5cm. Root vegetables such as therapist has assessed and
carrots, swede, parsnip, turnip advised that this food is safe
soften well as do brussel sprouts, for you to include.
broccoli & cauliflower florets. Rice
Lentils and beans Pudding rice, risotto and sticky
Tinned beans in sauce, such as rice that has been cooked until
baked beans, are soft. However, it is very soft and served in a
you must take care with the thick sauce that binds the rice
skins & avoid if advised by your together is suitable but other
speech and language therapist. types of rice will be too difficult
If you prefer to use dried beans to manage and should be
and lentils they must be well avoided.
cooked. Some can remain quite Pasta
hard even when cooked and may
Use tinned or very well cooked
need to be blended.
white pasta [shapes or spaghetti]
Breakfast cereal which has been chopped into
The texture must be fully bite size pieces no bigger than
softened and may contain soft, 1.5cm x 1.5cm and serve in
bite size lumps. Any excess milk a thick sauce, binding the
or fluid must be drained before pasta together.
serving.
Bread
Plain white or wholemeal bread
can be eaten if broken into
1.5cm pieces and softened /
Adding extra flavour & appetising
presentation

To flavour savoury dishes:- Smooth bottled sauces (for example,

tomato ketchup, brown sauce, barbeque sauce), smooth mustard,
mayonnaise, salad cream or smooth dips, herbs and spices, smooth
tomato or garlic puree, lemon or lime juice, vinegar

To flavour sweet dishes:- Custard or chocolate sauce, maple syrup,

treacle or honey, seedless jam, lemon curd, cream or crème fraiche,
condensed or evaporated milk, smooth yoghurt or fromage frais

Presentation:- prepare and serve meats or fish and vegetables

separately. Use different coloured vegetables e.g. carrot and broccoli

Are there any foods I should avoid?

Most foods can be softened, but there are exceptions.

• Raw, salad and stir fry vegetables
• Stringy, fibrous foods such as cooked celery, green beans,
pineapple
• Hard or dry foods such as nuts, crisps, flaky pastry or crackers
• Foods with skins or pith that cannot be removed e.g. citrus fruit,
garden peas, sweetcorn, grapes
• Foods with crusty or crispy toppings e.g. battered fish, chips
• Sticky or chewy foods e.g. marshmallows, soft jellies, dried fruit
• ‘Juicy’ food where the juice separates from the solid in the mouth
e.g. watermelon
Can I freeze prepared foods?
Storing portions of food in the freezer can save work. Divide food
into meal sized portions and store in clean plastic containers. E.g.
freezer bags, lollipop moulds, as well as small plastic boxes.
• Prepared food should be cooled and then frozen immediately.
• Do not store frozen food for more than one month.
• Check consistency when defrosted.

Food safety
It is important to guard against the risk of food
poisoning, especially if the food is being reheated
after freezing
• Always ensure food is thoroughly heated
• Never refreeze foods
• Never reheat cooked food more than once
• Defrost meat, poultry and fish thoroughly before cooking
• Avoid raw eggs and foods containing raw egg
• Check ‘Use by’ dates

For more information see the Food Standards Agency website:

www.food.gov.uk
 How can I make sure I get enough to eat?
You should aim to have a balanced diet to provide the protein, energy,
vitamins and minerals that your body needs. Eating a variety of foods
from all the main food groups (detailed below), following a regular
meal pattern and including nourishing snacks & drinks between your
meals if necessary will help you to meet your nutritional needs.

Starchy foods Fruit &

vegetables

Foods high in fat Protein rich foods

Milk and dairy foods

l Starchy foods l Milk and dairy foods
These should be included as These include milk and milk
part of every meal. Foods in products such as yoghurt,
this group include potatoes, and cheese. You should try
plantain, yam, cassava, rice, to include 2-3 servings a day.
pasta and breakfast cereals. One serving is 1/3 pint of
milk, 1 individual pot of
l Fruit & vegetables
yoghurt, 30g (matchbox size)
These should be included of cheese.
at least 5 times a day. Fresh,
frozen, tinned and juiced l Foods high in fat
products all count. Foods in this group should
normally be eaten sparingly.
l Protein rich foods Examples include spreading
These should be included as fats, cooking & dressing oils.
part of two meals per day. Unsaturated products such
Meat & meat substitute, fish, as olive oils and spreads
eggs, beans, lentils all count. are healthier options than
saturated products such as
butter or ghee.
Adding extra nourishment to your food
Foods and drinks that are high in calories are not normally necessary as
part of a healthy diet e.g. cream, creamy or oily dressings, ice cream,
condensed or evaporated milk, honey, jam, table sugar. However if you
are struggling to eat enough or losing weight these foods can help you
meet your calorie needs. This is called ‘fortifying your diet’ or ‘adding
extra nourishment to your food’. Ideas of how you could do this are
listed below.

Milk Powder Sugar, seedless

can be added to: jam, syrup, honey
Milk, breakfast cereal, potato, can be added to:
soups & sauces, custard & milk Drinks, breakfast cereal,
puddings, milk drinks. puddings, fruit
Grated or cream cheese Ice cream, custard,
can be added to: evaporated or condensed
Potato, vegetables, soups & milk
sauces, rice & pasta dishes can be added to:
Butter, margarine, oils, Drinks, breakfast cereals, sponge
mayonnaise, salad cream cake, fruit, puddings.
can be added to:
Potato, vegetables, soups &
sauces, rice and pasta dishes
Cream If you have been
can be added to: advised to limit these
Drinks, breakfast cereal, potato, foods in the past for
egg dishes, soups & sauces, rice example because you
and pasta dishes, puddings, fruit have diabetes or high
cholesterol talk to
your GP or dietitian.
Mealtime examples Soft & Bite Sized foods
The following mealtime examples must be softened unless they are
already the correct consistency. Remember some meats or fish may
need to be ‘minced & moist’ and sauces / liquids must be thick.
These examples can be adapted to your own taste and dietary needs.
If you have a diagnosed food allergy or intolerance please let
your dietitian or speech and language therapist know.
Breakfast • Fish cake with sweet potato,
Include some cereal avocado and sauce
• Ready brek®, weetabix® or • Turkey or chicken stew with
Oatabix® mixed with milk potato & swede mash and
cauliflower florets with gravy
• Porridge or instant oat cereal
or sauce
e.g. oats so simple®
and include some fruit • White fish in a parsley sauce
with sweet potato, broccoli
• Banana or stewed pear with florets
thick smooth yoghurt
• Curried chicken or fish with
and a cooked option (if desired)
potato & seedless, tinned
• Scrambled egg tomato
• Poached haddock, check for
bones, with thick tomato
Lighter meal suggestions
sauce and potato cake. • Smaller portions of any of the
above meals
Main meal suggestions • Soups
• Cottage pie (made with Home made: put vegetables
minced meat or meat and potato or bread with
substitute) with carrots & stock or milk and seasonings
gravy or sauce (to taste) in the liquidiser and
• Lentil based dishes such as blend. Try to include some
dahl with rice & tinned tomato lentils or split peas or cooked
• Corned beef hash with potato, meat or fish
broccoli florets and gravy or Tinned: may need to be
sauce liquidised and thickened.
 Tinned and packet soups • Milk jelly, smooth ice-cream,
do not provide much sorbet (avoid these desserts if
nourishment. This can be you have been advised to have
improved by adding Meritene® thickened drinks)
or Complan® powder, lentils or
split peas or meat or poultry, • Trifle, crumble and custard
cheese or milk powder or milk, Snacks:
cream
You could have a small serving
• Salmon with pasta and ripe of the lighter meal, breakfast or
avocado dessert options as a snack. Other
• Baked potato (leave the skin) options include:
with butter and topping e.g. • Melt in the mouth crisps e.g.
grated cheese, finely chopped Quavers®, Wotsits® or Skips®
chicken, tuna or egg mashed or supermarket own brands
with mayonnaise or salad • Biscuits dunked in hot drinks
cream (avoid biscuits that contain
• Scrambled egg with potato dried fruit, nuts or seeds)
cake and tomato sause • Moist cake (no dried fruit,
Desserts nuts, seeds)
• Yoghurt with soft fruit pieces
• Thick custard, mousse, instant
whip, blancmange, fruit fool
with soft fruit pieces, soufflé
• Fruit:
n Ripe banana or mango

n Peeled and de-stoned ripe

summer fruit e.g. peaches,

plums
n Tinned peaches

n Stewed fruit e.g. apple, pear

• Sponge (no dried fruit, nuts or

peel) or swiss roll with custard
or sauce
• Egg custard or crème caramel
Additional sources of information, resources
and support
There is a growing wealth of resources, information and support
available, particularly online. We are unable to recommend or
endorse specific resources, groups or information but would like
to highlight what is available.

Any information should be considered in conjunction with this leaflet

and your personalised recommendations. Be aware, there might be
different terminology used for used for soft & bite sized such as fork-
mashable, soft chopped or category E. Try and read reviews and forums
to help you decide what might be useful for you.

• Recipe books
• Online cooking tutorials e.g. YouTube
• Information websites e.g. dysphagia tool kit, dysphagia café
• Social media e.g. Facebook, Twitter
• Commercially prepared modified meal delivery services e.g.
o Local ‘meals on wheels’ services
o Wiltshire Farm Foods
o Oak House Foods
o Apetito
o Kealth
International Dysphagia Descriptors

For more information about the International Dysphagia

Descriptors see:
l http://iddsi.org/
l http://iddsi.org/wp-content/uploads/2016/03/
160103_Foods-Detailed-Descriptions.pdf
 Key points to remember

Signature: Date:

Photo on page 3 supplied by Apetito

Written in partnership
 Minced &
Moist Diet

The information in this booklet is for:

This booklet has been given by:

Contact number:

Date:
It has been recommended that
you have a Minced & Moist diet
to make it easier and safer to eat.
You can still eat and drink many of the foods and fluids you enjoy,
although the consistency may need to be altered.

The speech and language therapist may have advised you to alter the
consistency of your food and drink. It is important that you follow
this advice in order to remain fit and well. Following the advice will
help to reduce the distress of coughing at mealtimes and the risk of
developing chest infections.

The speech and language therapist will also advise you on the
best way to eat and drink, for example when upright and when
most alert.
The dietitian can advise
on ways to ensure your
Minced & Moist diet
is well balanced and The diet consistency
nutritious. you have been recommended
is Minced & Moist
Please read this leaflet The fluid consistency you have
in conjunction with been recommended is
your personalised
recommendation.

IDDSI 5 previously cat D, known as fork mashed, pre-mashed

What is a Minced & Moist diet?
It is “ordinary” food that is soft, moist and tender, and:
• Can be eaten with a fork, spoon or chopsticks.
• Can be scooped and shaped on a plate.
• Is soft and moist with no separated thin liquid i.e. It is not a runny
sauce containing lumps or bits for example minestrone soup,
Rice Krispies© & Cornflakes© with milk.
• Has small lumps visible within the food (children 2-4 mm & adult
4mm) and lumps are easy to squash / mash with a fork, spoon or
the tongue.
• Does not require biting and requires very little chewing
i.e. It is not hard, tough, chewy, fibrous, stringy, dry or crispy;
it has no hard skin, bone or gristle.

10
mm
How will I know that I have the right texture?
Fork pressure Spoon tilt
When pressed with a fork the It holds together and keeps
food particles should easily its shape on the spoon. A full
separate between & come spoonful will slide/pour off
though the prongs. Very little the spoon if the spoon is tilted
pressure should be needed to or turned sideways or shaken
do this i.e. pressure should lightly. It should slide off easily
not make the thumb nail blanch with very little food left on the
to white. spoon i.e. Not sticky.

Fork drip Chopsticks

A scooped sample should sit in Can be used to scoop or hold
a pile or mound on the fork and the food if the sample is moist
does not easily or completely and holds together.
flow or fall through the prongs.
Fingers
It is possible to easily hold a
sample of minced & moist food
using fingers. The small, soft,
smooth, particles can be easily
squashed between fingers.It will
feel moist and leave fingers wet.
How do I make the food I like into a
Minced & Moist consistency?
There are many ‘ordinary’ foods that are already the correct
consistency whilst others will need adapting. Think about the food
you would usually eat and use the guidance in this booklet to help
you to achieve the correct texture where necessary.

What equipment will I need?

Many foods will mince / mash down with a fork. A potato masher
may be useful and an electric hand blender. Remember that not
all foods will need blending and you don’t need to blend until
the food is smooth.
How do I prepare a Minced & Moist diet?
Please be aware that these are guidelines only. How
you cook the food i.e. temperature and duration, can
significantly change the consistency and texture of the
finished item.

Meat & meat substitute Eggs

Tenderised & finely minced or Softly scrambled, egg custard,
chopped [2mm-4mm pieces]. well mashed boiled eggs with
Serve in very thick, smooth, mayonnaise.
non-pouring sauce or gravy.
Fruit
Fish Fresh or cooked fruit can be
Poach or steam and finely included, however cooked fruits
mince (remember to remove all may be easier to prepare safely.
the bones). Serve in very thick, Remove the skins, mince / mash
smooth, non-pouring sauce. the fruit and drain any excess
fluid before eating. Be cautious
with fruit with small seeds or pips.
Examples of liquids that
Vegetables
can be used to cook /
tenderise the meat Remove the skins and steam
and fish are gravy, or boil until they are soft.
stock, homemade or Serve minced / mashed. Root
readymade sauces. The vegetables are the easiest to
liquid can be thickened mince / mash e.g. Carrots,
with flour, corn flour or swede, parsnips, turnips and
prescribed thickeners potatoes. Brussels sprouts,
before serving. broccoli and cauliflower florets
also mince / mash well.
Lentils and beans Bread
Tinned beans in sauce, such Plain white or wholemeal bread
as baked beans, mince / mash can be eaten if broken into
well. However, you must take 2mm-4mm pieces and softened
care with the skins and avoid / soaked in soups or sauces.
if advised by your speech and Bread should not be eaten
language therapist. If you use in any other way unless
dried beans and lentils they your speech and language
must be well cooked. Some can therapist has assessed and
remain quite hard even when advised that this food is safe
cooked and may need blending. for you to include.

Breakfast Cereal Rice

These should be very thick and Pudding rice, risotto and sticky
smooth. They can contain small rice that has been cooked until
it is very soft and served in a
(2mm-4mm) soft lumps. The
food should be fully softened thick sauce that binds the rice
together is suitable but other
and any milk / fluid must not
separate away from the cereal. types of rice will be too difficult
Excess fluid should be drained to manage and should be
before serving. avoided.

Pasta
Use tinned or very well cooked
white pasta (shapes or spaghetti)
which has been minced /
mashed and served in a thick
sauce to bind the pasta together.
Adding extra flavour
and appetising presentation

To flavour savoury dishes

Smooth bottled sauces (for example, tomato ketchup, brown sauce,
barbeque sauce), smooth mustard, mayonnaise, salad cream or
smooth dips, herbs and spices, smooth tomato or garlic puree, lemon
or lime juice, vinegar.
To flavour sweet dishes
Custard or chocolate sauce, maple syrup, treacle or honey, seedless
jam, lemon curd, cream or crème fraiche, condensed or evaporated
milk, smooth yoghurt or fromage frais.
Presentation
Prepare and serve meats or fish and vegetables separately. Use
different coloured vegetables e.g. Carrot and broccoli.

Are there any foods I should avoid?

Most foods can be minced, but there are exceptions. The following
do not usually mince well.
• Raw, salad and stir fry vegetables.
• Stringy, fibrous foods such as cooked celery, green beans,
pineapple.
• Hard, dry foods such as nuts, crisps, flaky pastry, crackers.
• Foods with skins or pith that cannot easily be removed e.g. citrus
fruit, garden peas, sweetcorn, grapes.
• Foods with crusty or crispy toppings e.g. battered or breaded
fish, chips.
• Sticky, chewy foods e.g. marshmallows, soft jellies, dried fruit.
Can I freeze prepared foods?
Storing portions of food in the freezer can save work. Divide food
into meal sized portions and store in clean plastic containers
e.g. freezer bags, ice lolly moulds, as well as small plastic boxes.
• Prepared food should be cooled and then frozen immediately.
• Do not store frozen food for more than one month.
• Check consistency when defrosted.

Food safety
It is important to guard against the risk of food
poisoning, especially if the food is being reheated
after freezing
• Always ensure food is thoroughly heated
• Never refreeze foods
• Never reheat cooked food more than once
• Defrost meat, poultry and fish thoroughly before cooking
• Avoid raw eggs and foods containing raw egg
• Check ‘Use by’ dates

For more information see the Food Standards Agency website:

www.food.gov.uk
 How can I make sure I get enough to eat?
You should aim to have a balanced diet to provide the protein, energy,
vitamins and minerals that your body needs.Eating a variety of foods
from all the main food groups (see below), following a regular meal
pattern and including nourishing snacks and drinks between your
meals if necessary will help you to meet your nutritional needs.

Starchy foods Fruit &

vegetables

Foods high in fat Protein rich foods

Milk and dairy foods

l Starchy foods l Milk and dairy foods
These should be included as These include milk and milk
part of every meal. Foods in products such as yoghurt,
this group include potatoes, and cheese. You should try
plantain, yam, cassava, rice, to include 2-3 servings a day.
pasta and breakfast cereals. One serving is 1/3 pint of
milk, 1 individual pot of
l Fruit & vegetables
yoghurt, 30g (matchbox size)
These should be included of cheese.
at least 5 times a day. Fresh,
frozen, tinned and juiced l Foods high in fat
products all count. Foods in this group should
normally be eaten sparingly.
l Protein rich foods Examples include spreading
These should be included as fats, cooking & dressing oils.
part of two meals per day. Unsaturated products such
Meat & meat substitute, fish, as olive oils and spreads
eggs, beans, lentils all count. are healthier options than
saturated products such as
butter or ghee.
Adding extra nourishment to your food
Foods and drinks that are high in calories are not normally necessary as
part of a healthy diet e.g. cream, creamy or oily dressings, ice cream,
condensed or evaporated milk, honey, jam, table sugar. However if you
are struggling to eat enough or losing weight these foods can help you
meet your calorie needs. This is called ‘fortifying your diet’ or ‘adding
extra nourishment to your food’. Ideas of how you could do this are
listed below.

Milk Powder Sugar, seedless

can be added to: jam, syrup, honey
milk, breakfast cereal, potato, can be added to:
soups & sauces, custard & milk drinks, breakfast cereal,
puddings, milk drinks puddings, fruit
Grated or cream cheese Ice cream, custard,
can be added to: evaporated or condensed
potato, vegetables, soups milk
& sauces, rice & pasta dishes can be added to:
drinks, breakfast cereals, sponge
Butter, margarine, oils,
cake, fruit, puddings
mayonnaise, salad cream
can be added to:
potato, vegetables, soups
& sauces, rice and pasta dishes

Cream If you have been

can be added to: advised to limit these
foods in the past for
drinks, breakfast cereal,
example because you
potato,egg dishes, soups &
have Diabetes or high
sauces, rice and pasta dishes,
cholesterol talk to
puddings, fruit
your GP or dietitian