Eating when it is more difficult

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THIS CONTAINS INFORMATION ABOUT YOUR EATING AND DRINKING.

It is designed to give practical guidance to help follow advice you have been given by your Health Care Professionals. If you have any questions please contact your Dietitian or Health care Professional working with you.

INTRODUCTION

This booklet is designed to give practical ideas to help you prepare a soft diet, providing all the food groups to meet your nutritional needs.

It is for those who need to modify their diet, without specific IDDSI recommendations from a Speech and Language Therapist. You may have experienced issues chewing and swallowing harder & tougher foods.

You may have one or more of the following which means you may benefit from these dietary suggestions:-

Dentures/ lack of teeth meaning difficulties with regular diet.
Temporary mouth discomfort or pain.
Oesophageal issues/ cancer
Head and neck cancer
Completing treatments e.g. radiotherapy
Respiratory problems such as: COPD, asthma.

The Eatwell guide shows foods in the proportions you should eat them and offers suggestions on how to maintain a balanced diet containing a range of nutrients.

Fruit & vegetables
Starchy carbohydrates
Protein sources
Dairy products & alternatives
Oils & spreads

Note; lists of foods “to try” and “to avoid” in the following pages are a general guide, foods tolerated can vary from person to person.

1. FRUIT & VEGETABLES

Aim to have 5 portions a day. A portion is usually about a handful or 80g.

Foods to try	Foods to avoid
Well-cooked root vegetables e.g. carrot & swede, parsnip mashed with butter, oil & milk.	Vegetables which can be tough and stringy with skins e.g. runner beans, celery
Cauliflower and broccoli florets in a sauce e.g. cheese sauce	Cut off the stalks when having cauliflower or broccoli.
Ratatouille e.g. courgette, peppers and aubergine (without skin) chopped up into small pieces and thoroughly cooked, in tomato sauce	Vegetables without a sauce if you are experiencing problems.
Homemade vegetable soups (a blender) Tinned vegetables- well cooked, mash if required	Chunkier soups. Raw vegetables.
Soft fruits e.g. peaches, bananas, avocado, mango (without skin/ peel).	Fruit with skins, pith and pips e.g. grapes, oranges & citrus fruit (but can be eaten if these are removed). Dried fruit
Tinned fruit e.g. peaches, apricots, pears. Mashed mandarins.	Fruits with a stringy texture e.g. pineapple.
Fruit juice e.g. orange/ apple & smoothies.	Avoid those with seeds if cause issues e.g. raspberries.
Stewed fruits e.g. apple/ pears	Hard raw fruit

2. STARCHY CARBOHYDRATES

3 to 5 portions a day, aim to have one with each meal.

Foods to try	Foods to avoid
Porridge, Ready Brek, Weetabix, other cereals with hot or cold milk or water	Cereals with nuts, seeds & dried fruit e.g. granola, muesli.
Soft bread (without seeds). Removal of crusts may be easier. Add cream cheese, egg or tuna mayonnaise, dips or hummus to make even softer. Chapattis with yoghurt or lots of butter/margarine	Crusty & chewy breads e.g. baguettes, granary breads & pizza.
Mashed boiled potato, sweet potato, plantain & yams (with butter, milk, oil). Jacket potato (without skins) with soft filling.	Jacket potato skins
Pasta (small pasta pieces), with sauce e.g. macaroni cheese, ravioli, lasagne sheets in sauce	Tough pastries
Rice – thoroughly cooked (curry/ or sauce can soften further)	Wild / or brown rice
Biscuits dunked in hot drinks e.g. tea/ hot chocolate Crackers dipped in hot soup- so soft enough to eat & swallow Crisps which melt/ soften in mouth due to their texture e.g. corn “puff/ melt in mouth” crisps.	Dry biscuits Dry crackers Hard crisps Nuts

3. PROTEIN SOURCES

Aim for 2 to 3 servings a day of this food type

Foods to try	Foods to avoid
Flaked white fish with sauce	Watch out for bones in fish
Tinned fish with mayonnaise e.g. tuna, salmon
Minced meat/ Quorn- e.g. Bolognese, shepherd’s pie, chilli con carne. Tender meats e.g. chicken, offal in casseroles, soups and stews. Tinned meats e.g. corned beef, ham Tofu, textured vegetable protein	Hard and stringy meats e.g. steak, bacon, sausages unless chopped up/ with sauce
Soft eggs, e.g. scrambled, poached Quiche, egg mayonnaise, omelette	Fried eggs may be challenging for some
Cauliflower cheese, soft cheeses added to foods e.g. ricotta and cottage cheese
Soft lentils or beans (cooked well, may need to be mashed
Nut butters e.g. peanut/ almond butter	Nuts and seeds

4. DAIRY PRODUCTS AND ALTERNATIVES

Aim for 3 servings a day

Foods to try

200mls whole milk/ lactose free milk/ soya alternative fortified with calcium

Yoghurt 125g pot

Hard cheese grated into soft products 30g– match sized box

Cottage cheese 100g

Rice pudding/ ice cream

5. OILS AND SPREADS

Olive, sunflower, and rapeseed oils and spreads

Meal ideas

Meal Type	Foods to include in meal
Breakfast	Cereals softened in warm or cold milk. Omelette, scrambled or poached eggs. Smoked haddock, smoked salmon. Soft fruit (e.g. banana, canned peaches). Yoghurt with soft fruit, smoothies made with blitzed fruits. Fruit juice
Main Meal	Egg dishes (e.g. omelette, quiche– may need to remove the pastry) Tender meats e.g. pulled pork, mince in gravy. Meat substitutes, e.g. Quorn, tofu. Beans: baked beans or canned beans without tough skins. Pasta with sauce (cheese/ mushroom/ tomato) Lasagne/ vegetable moussaka Potatoes: baked (inside but not skins), soft (but not crunchy) chips. Soft cooked fish. Vegetable ratatouille Dahl made with soft lentils Soups: e.g. chowder, minestrone. Rice: in sauces, risottos etc. Soft vegetables + butter/ melted cheese
Desserts/ snack	Puddings: steamed, sponge, bread and butter pudding, etc. with custard/ cream Trifle/ angel delight Soft biscuits/ wafers (dunked) Soft dried fruit (e.g. prunes, soft apricots etc.: not hard dried fruit). Chocolate that melts in the mouth and does not have hard pieces such as nuts or biscuit in it. Soft baked breakfast bars with fruit filling. Fruit and chocolate yoghurts and mousses Cheese: soft cheeses, not pieces of hard cheese such as parmesan. Hummus/ guacamole

TOP TIPS

Add gravies, sauces, custards to keep foods soft and moist.
Sip regularly between mouthfuls.
Chew foods thoroughly, before swallowing them. Take your time.
Check for visible bones and gristle/ fat on fish and meats.
Season foods with salt, pepper, herbs and spices to make it more appealing & tasty.
Use your fork to do some extra mashing if required.

ADDING EXTRA NUTRITION
If you have concerns about losing weight or can only manage small quantities of food at a time, here are some ways to enrich your food, and give you extra protein and energy.

Eat 5-6 small meals or snacks a day, instead of 3 large meals.
Don’t be afraid to choose softer ready made meals for convenience
Complan and meritene shakes can be purchased over the counter.
Avoid low fat and low sugar foods.
You will benefit from eating more from groups 3, 4 and 5 on the Eatwell guide.

FOOD FORTIFICATION

Try drinks made with full fat milk e.g. Horlicks, hot chocolate.
Incorporate yoghurt, cheese spread, cream, olive oil and spreads into potato, soups, sauces and savoury items.
To puddings; add cream, ice cream, sugar, jam, golden syrup and honey
Try adding fortified milk powder to full fat milk, drinks, soups and puddings. Look at packaging instructions for how to make up.

If you lose weight, a doctor/ specialist nurse may refer you to a dietitian who can further discuss diet, and may suggest additional supplement drinks on prescription.

Worcestershire Acute Hospitals NHS Trust
Covering the Alexandra Hospital, Redditch, Worcestershire Royal Hospital and
Kidderminster Hospital
Tel: 01905 760 136
Email: wah-tr.dietetics@nhs.net

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Thursday from 8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.

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