Texture modified diet - soft - dysphagia

Aim

To provide a diet of soft-textured foods that can be easily chewed, requiring minimal biting, for patients with dysphagia.

Characteristics

Texture A – soft. Foods in this category may be naturally soft, or cooked or cut up to alter texture. Food should be easily broken up with a fork or be served cut up to a target maximum particle size of 1.5 x 1.5cm. Foods should be easily broken up in the mouth with minimal chewing required. Food should be moist or served with a sauce or gravy to increase moisture content. This diet texture can be applied to any portion size and most therapeutic diets.

Indications

• for patients with swallowing difficulties

Nutritional adequacy

Nutritionally adequate, but may be low in dietary fibre. Patients ordered this diet should be monitored regularly to ensure adequate dietary intake.

Precautions

All foods to be naturally soft, minced or mashed, slightly firm but not tough or stringy, and without rind, gristle or bone. This diet is not necessarily a light diet (ie it can be spicy). All beverages, sauces and gravies must be thickened to the appropriate level for individuals also prescribed thickened fluids. Patients suitability for bread needs to be considered on a case by case basis by a Speech Pathologist.

Paediatrics

Suitable for use in paediatrics (for children aged 5 years old or more) when combined with an age-appropriate diet. Not suitable for children under 5 years of age (refer to Paediatric Diet Specifications).

Specific menu planning guidelines

Note: This is a general guide - specific items require approval by Speech Pathologists.

	Allowed	Not allowed
Hot main dishes	Soft dishes that can be mashed with a fork (e.g. tuna / salmon mornay, soft macaroni cheese, flaked fish, cottage pie, tofu) Soft dishes cut up (e.g. lasagne, smooth quiche with crumbly base, fish cakes, crêpes) Roasts meats to be diced and served with gravy Well-cooked legumes (e.g. baked beans)	Sliced roasted meats or grills Meat with gristle Crumbed or fried fish Dishes with hard pastry or a hard base (e.g. pizza) Casseroles with large pieces (e.g. curried prawns) Dishes with crisp topping
Sauces, gravies	All	-
Starchy vegetables / pasta / rice	Well cooked vegetables without skin Mashed and scalloped potato Chopped pasta or well-cooked rice with plenty of sauce	Crispy or crunchy vegetables (e.g. roasted, baked or deep fried) Jacket or boiled new potatoes with skin Rice or pasta (if dry)
Vegetables	Most vegetables, if soft enough to mash with fork Soft canned vegetables	Raw vegetables Fibrous vegetables (e.g. corn, celery, broccoli stalks)
Soups	All others (may contain soft pieces e.g. pasta)	Soups with hard or large pieces of meat or hard vegetables e.g. corn kernels
Sandwiches	None	-
Salads, dressings	Salads using allowed ingredients e.g. potato salad	All others e.g. garden salad
Breads, cereals	Rolled oats, semolina, cold breakfast cereals moistened with milk, soft pancakes Unprocessed bran may be stirred into moist cereal to increase fibre	All bread Hard cereals that do not soften easily (e.g. toasted muesli) Cereals with nuts, dried fruit or seeds (e.g. Sultana Bran®, Just Right®)
Spreads	All	-
Hot breakfast choices	Eggs (except fried), baked beans, canned spaghetti, creamed corn	All others (e.g. fried egg, bacon, sausages)
Fruit	Cut up canned or stewed fruit Soft ripe fresh fruit e.g. bananas, pawpaw, chopped soaked prunes.	Other fresh fruit and dried fruit Grapes, canned pineapple, stewed rhubarb
Yoghurt	All yoghurt and yoghurt-like desserts (e.g. Fruche®) (including those with soft fruit)	Yoghurt with seeds, nuts, muesli or hard pieces of fruit
Desserts	Milk-based soft desserts (e.g. custards, mousses, cut up trifle, creamy rice, puddings) Moist cakes (sauce, custard, cream etc. may be required) Ice-cream Jelly Jellied fruit (with small fruit pieces)	Any desserts with hard pastry Dry cakes without custard, cream or sauce Cake with dried fruit, nuts seeds or coconut
Milk and cheese	All milk Cottage cheese, ricotta, camembert, soft cheddar (grated or soft cheese slices)	Hard cheeses Crisp cooked cheese topping on hot dishes
Beverages	All	-
Biscuits	None	-
Miscellaneous	Liquid or pudding Nutrition supplements Soft smooth chocolate Cream, pepper, salt, sugar, sweetener	Nuts, seeds and coconut Hard lollies

References

1. Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.
2. Dietitians Association of Australia and The Speech Pathology Association of Australia Ltd. Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definition. Nutrition & Dietetics 2007;64 Suppl 2:S53-76.