Liquidised – Level 3

Liquidised – Level 3

LIQUIDISED

 Level 3

THIS BOOKLET CONTAINS IMPORTANT INFORMATION ABOUT YOUR EATING AND DRINKING. It is designed to give you practical guidance to help you follow the advice you have been given by the Speech & Language Therapist and Dietitian.

Provided by Worcestershire Acute Hospitals NHS Trust and Worcestershire Health and Care NHS Trust

INTRODUCTION

This booklet is designed to give you practical guidance to help you follow the advice you have been given by the Speech & Language Therapist (SLT) and/or Dietitian.

WHAT ARE SWALLOWING PROBLEMS?

Swallowing problems are known as dysphagia which can affect the ability to eat and drink. 

You may have been assessed by a Speech and Language Therapist who recommended you have liquidised food.

A Dietitian can give you advice on how to achieve a balanced diet.

Changing food and drink consistency

• Modified textures (consistencies) may help you swallow more easily and safely.   An SLT may assess your swallow and let you know the most beneficial  consistencies  of food and drink for you. 

• This reduces the likelihood of food going the ‘wrong way’ and entering the lungs (aspiration), rather than the stomach.  This can result in coughing, choking and/or chest infections.

Where to find more information about creating modified texture diets:

• Altered food and drink consistencies are given labels called ‘Levels’ with a number (e.g. Level 1, Level 3). This helps you know what consistency of food and drink is safest.  This labelling system is called  IDDSI.

• The IDDSI website https://iddsi.org/ has more information on different food consistencies, including information for people who are preparing the food. 

ADVICE TO ENCOURAGE SAFER EATING AND DRINKING

Mouth Care

• Your mouth should be clean and moist.  If you usually have a dry mouth, discuss this with your Doctor and/or Speech and Language Therapist.

• If you have dentures, they should be worn while eating (provided they fit well).  You may wish to consider dental fixative.  Dentures should be clean.

Positioning

• Preferably sit out in a chair to eat or drink.

• If in bed, sit so you are not leaning to the side or slumped over.  Use pillows, if needed, to support you and maintain a straight upright  position.

• Your head and chin should be in a central position, not tipped sideways, backwards or forwards. Unless otherwise specified by your SLT.

Pacing

• Take the time you need, do not rush.

• Swallow each mouthful before taking the next. Don’t overfill your mouth.

• Take a single sip at a time. Don’t gulp the drink.

Utensils

• Use normal cups and beakers unless otherwise recommended. Your Speech & Language Therapist may advise you whether it is appropriate to use straws, spouted cups or adapted drinks containers.

• You may benefit from equipment that makes eating and drinking easier (e.g. plate guards, adapted cups and cutlery, non-slip mats).   This equipment can be bought online, or you may wish to consult an Occupational Therapist about what equipment might help.

Liquidised diet : level 3

• Food is of a smooth texture.

• No bits or lumps (fibres, bits of shell or skins, husk, particles of gristle or bone). You may need to sieve the food to achieve this.

• Does not need chewing.

• Cannot be piped, layered or moulded on a plate.

• Cannot be eaten with a fork because it drips slowly in dollops           through the prongs.

• Can be eaten with a spoon or drunk from a cup

• Do not give pre-packaged baby food as the only source of nutrition as it does not contain the correct nutritional content for an adult.

Fork Drip Test:

How to prepare liquidised food:

• Use a hand blender, liquidiser, or food processor.

• Food can also be sieved to achieve a smooth texture.

• Cook food as usual and cut into small pieces to aid blending.

• You can add  extra moisture to food  to help make a smooth texture when blending (e.g. white sauce, cheese sauce, gravy, tomato based sauce, milk, cream, custard, apple sauce, butter).

• Thickener, flour or cornflour can be added to maintain thickness.

• Avoid stringy foods such as celery  or runner beans and foods with a tough skin e.g. beans, peas or sweetcorn—these foods do not liquidise well.

Alternatively, pre-prepared food can be purchased from suppliers such as those listed on page 11. However, they only supply pureed food, you will need to add additional liquid/sauces such as stock, gravy, milk/cream etc. to make the food into a liquidised consistency.

Liquidised diet : level 3

Meal Suggestions
Breakfast	· Yoghurt (smooth) or fromage frais. · Smoothie (no bits). · Fruit or vegetable juices. · Liquidised overnight oats. · Liquidised porridge, Ready Brek, or halwa (without puri). · Liquidised scrambled egg and liquidised beans.
Main Meals	· Smooth soups or broths (no bits). · Liquidised curry (meat/vegetable/lentil) with a sauce. · Liquidised casserole/stew e.g. bigos/gulasz/nihari. · Liquidised khichdi. · Liquidised cottage/shepherd’s pie. · Liquidised cauliflower cheese or macaroni cheese. · Liquidised tinned pasta e.g. ravioli, spaghetti. · Liquidised fish pie with a thick sauce, e.g. cheese. · Liquidised tinned refried beans or hummus thinned with stock.   Meals can be served with liquidised potatoes – can add cheese, butter, cream, gravy, cream/soft cheese. All  meals can be served with liquidised vegetables, e.g. carrot, swede, broccoli, parsnips, cauliflower. They can either be blended together or separately as per your preferences.

Liquidised diet : level 3

Meal Suggestions
Desserts	· Smooth yogurt (no bits) or fromage frais. · Mousse. · Instant whip. · Liquidised rice pudding or semolina. · Liquidised ryz z jabłkami. · Liquidised kheer. · Liquidised fruit with whipped cream or custard. · Cake (finely blended) into custard or milk. You can also have jelly and ice-cream/frozen yogurt as long as you have not been recommended to have thickened fluids as these turn into a thin fluid in the mouth.
Snacks	· Smoothie (no bits). · Smooth soup (no bits). · Milkshakes. · Hot drinks e.g. hot chocolate, Bovril. · Liquidised avocado. · Lassi (no froth) · Cup-a-soups (smooth with no vegetable pieces or croutons).

You may find it easier to ‘batch’ cook, producing several portions at the same time and storing appropriately (e.g. freeze) to use at a later date.

Be careful of excess liquid when food items are defrosted and ensure this is mixed into the food thoroughly or removed.

How to improve flavours:

The taste of your food is important, here are some ideas to make your food more appetising:

Savoury	Sweet
· Salt/pepper · Curry powder · Herbs/spices · Garlic · Lemon · Tomato sauce/puree · Cheese or parsley sauce · Gravy granules · Worcester sauce	· Coffee · Cocoa/drinking chocolate · Honey · Seedless jam · Lemon curd · Fruit syrups · Squash · Cinnamon · Nutmeg · Ginger

What to do if you are losing weight or underweight?

• Use full fat products, e.g. whole milk instead of skimmed or semi-skimmed.
• Try ‘little and often’ – aim for 3 small meals a day and 3 snacks.
• Have nourishing snacks between meals.
• Have nourishing drinks between meals (fortified full fat milk, hot chocolate, malted milk drinks).

Food fortification:

You can fortify foods to boost nutritional content. This helps prevent weight loss or promote weight gain.

• Fortified full fat milk. Add 2-4 tablespoons of skimmed milk powder to 1 pint of full fat milk (this can be used in cooking e.g. in mashed potatoes, sauces, porridge and puddings or to drink).

• Add grated cheese to foods like mashed potatoes, scrambled eggs, soups before liquidised.

• Add double cream to foods before liquidising e.g. soups, potatoes, porridge.

• Add honey/jam/sugar/syrup to foods.

• Add butter/spread or oil such as olive/rapeseed oil to foods before liquidising e.g. potatoes, vegetables, scrambled eggs.

If you continue to lose weight your GP may refer you to a Dietitian

How to have a healthy balanced diet

• Fruit and vegetables: aim to have 5 portions per day, includes fresh, frozen or tinned.

• Milk and dairy foods: aim to have 3 servings per day.

• Protein: (meat, fish, eggs, beans and other non-dairy sources of protein), aim to have 2-3 servings per day.

• Carbohydrates: (bread, rice, pasta, potatoes and other starchy foods), aim to have 3-5 servings per day.

• Food and drink high in fat and/or sugar: if overweight, limit these foods, if underweight these foods can help you gain weight, therefore include more in your diet.      

Supplements

If you have tried food fortification and are still losing weight or are unable to gain weight, you may need to trial oral nutritional supplements.

These can be purchased from a chemist or pharmacy (e.g. Complan, Meritene or Aymes soups/shakes). Please be cautious if you are on thickened fluids as over the counter supplements may not be the correct thickness for the IDDSI level you have been recommended.  Please speak to your GP, Dietitian or SLT for further information if needed.

IDDSI picture (page 4) from: http://ftp.iddsi.org/Documents/Complete_IDDSI_Framework_Final_31July2019.pdf

USEFUL INFORMATION—some options for food suppliers

Simply Puree	Apetito
Tel: 0191 456 0456	Tel: 01225 234509
https://simplyfoodsolutions.co.uk/simply-puree/	http://www.apetito.co.uk/
NH Case Ltd	Oak House Foods
Tel: 01963 828900	Tel: 0333 370 6700
http://www.nhcase.com/	https://www.oakhousefoods.co.uk/
Wiltshire Farm Foods	Mrs Gills Kitchen
Tel: 0800 077 3100	Tel: 020 8807 6584
https://www.wiltshirefarmfoods.com/	https://mrgills.co.uk/

USEFUL CONTACTS

SPEECH AND LANGUAGE THERAPY

Acute adult service—Worcestershire Acute Hospitals NHS Trust

Covering the Alexandra Hospital, Redditch and Worcester Royal Hospital.

Tel No: 01905 760 475

Email: [email protected]

Community Adults—Worcestershire Health and Care NHS Trust

Covering the community; including rehabilitation wards and places of residence, e.g. home, nursing/care homes.

Tel No: 01905 681 049

DIETITIAN

Acute Service—Worcestershire Acute Hospitals NHS Trust

Covering the Alexandra Hospital, Redditch, Worcestershire Royal Hospital and Kidderminster Hospital.

Tel No: 01905 760 136

Email: [email protected]

Community Dietitian—Worcestershire Health and Care NHS Trust

Tel No: 0300 123 8098

Produced by: Speech & Language Therapy Nutrition & Dietetic Departments   Worcestershire Acute Hospitals NHS Trust

Updated: June 2026

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