Texture modified diet - smooth puree - dysphagia

Aim

To provide a diet that is smooth and lump free, which requires no chewing.

Characteristics

Texture C – smooth pureed. Food in this category is smooth and lump free, but may at times have a grainy quality. It is similar in consistency to a commercial pudding. Food could be moulded, layered or piped. Food should be cohesive enough to hold its shape on a spoon. When placed side by side on a plate, the consistencies should maintain their position without bleeding into one another. This diet texture can be applied to any portion size and most therapeutic diets.

Indications

• may be ordered for patients with swallowing problems
• poor dentition or no dentures
• painful mouth.

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 beverages, sauces and gravies must be thickened to the appropriate level for individuals also prescribed thickened fluids.

Paediatrics

Suitable for use in paediatrics when combined with an age-appropriate diet.

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	Pureed meats or fish, with a sauce or gravy to achieve a thick moist texture Soufflés and mousses (e.g. salmon mousse) Pureed legumes with no husk in final puree Soft silken tofu	Minced or partially pureed dishes
Sauces, gravies	Smooth pureed sauces without lumps (e.g. smooth cheese or white sauce, gravy)	Any with seeds or lumps (e.g. onion or fresh tomato sauce)
Starchy vegetables / pasta / rice	Very smooth mashed potato Pureed pasta or noodles with sauce Pureed rice with sauce	All others including coarsely mashed potato
Vegetables	Pureed vegetables Added milk and margarine may be used to increase energy density	Coarsely mashed vegetables Pureed vegetables containing lumps Particles of vegetable fibre or hard skin
Soups	Pureed to remove all lumps	Soup with any vegetable fibre or lumps
Sandwiches	None	-
Salads, dressings	None	-
Breads, cereals	Smooth lump-free breakfast cereal (e.g. pureed rolled oats, semolina)	All breads Cereals that do not soften easily, or with fruit or seeds (e.g. muesli)
Spreads	Jams without seeds or peel; honey	Jams with seeds, marmalade, peanut butter
Hot breakfast choices	Pureed scrambled egg, pureed baked beans or pureed canned spaghetti	All others that have not been pureed
Fruit	Pureed fresh, canned or stewed fruit Very well-mashed banana	All others, including pureed fruit with any visible lumps
Yoghurt	Lump-free yoghurt and yoghurt-like desserts (e.g. Frûche®)	Fruit yoghurts with visible fruit pieces or seeds
Desserts	Smooth desserts (e.g. custards, mousses, blancmange, smooth puddings) Soft meringue Ice-cream with smooth toppings or syrup Gelled cake*	Any desserts with fruit pieces, seeds, nuts, crumble, pastry or non-pureed garnishes
Milk and cheese	All milk, milkshakes, smoothies Smooth cheese paste (e.g. smooth ricotta)	All solid and semi-solid cheeses (including cottage cheese)
Beverages	Tea, coffee, cordial, soft drink, milk, fruit juice without pulp	Fruit juice with visible pulp
Biscuits	None	-
Miscellaneous	Liquid or pudding nutrition supplements Cream, pepper, salt, sugar, sweetener	Lollies, jelly, coconut, nuts, seeds and grains

* Cake that has been soaked in jelly or gel so that the entire food portion becomes soggy

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.