Pureed Diet – Level 4

Pureed Diet – Level 4

PUREED DIET

 Level 4

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 pureed 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 (eg: Level 1, Level 4) to help you know exactly what type of food and drink is safest.  This labelling system is called  IDDSI.

• The IDDSI website https://iddsi.org/ has  more information on different food consistrencies, 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.

• Ensure mouth, teeth and/or dentures are cleaned at least twice daily.

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 SLT 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.

Pureed diet : level 4

• Food is of a thick smooth consistency. 

• Holds its shape on a plate or when scooped and can be eaten with a fork or spoon:
• It should slide easily off the spoon or fork (not stick to the utensil), and hold it’s shape on a plate.
• When scooped onto the fork, most of the food should sit in a mound or pile on the fork.
• When pushed with a fork, should retain the indentation.
• A very small amount ( a ‘drip’) may fall through the fork and form a ‘tail’ below the fork.
• The food should not flow, dollop or drip continuously through the prongs.

• It can be piped, layered or moulded.

• Should not separate into liquid and solid components.

• It cannot be poured, cannot be drunk from a cup, cannot be sucked through a straw.

• No bits or lumps – you may need to sieve the food to achieve this.

• Does not need chewing.

• 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.

How to prepare pureed food:

• Use a hand blender, liquidiser, food processor. Food can also be sieved to get 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 pureed texture when blending (e.g. white sauce, cheese sauce, gravy, tomato based sauce, milk, cream, custard, apple sauce, butter).
• If food becomes too thin you can add thickener to gain the right texture e.g. cornflour, instant mashed potato or drinks thickener.
• 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 puree well.
• Avoid any loose liquids (e.g. gravy, milk, custard or ice-cream) if  you are also having thickened fluids as they are not suitable.

How to present pureed food:

• Puree each food item separately and keep them separate on the plate:
• This will make the food more appealing and appetising.
• It helps to retain the individual taste and colour of each food item.
• Food moulds are available, but you can also use ice cream scoops or piping bags with different nozzles.
• Alternatively, pre-prepared pureed food can be purchased from suppliers such as those listed on page 11.

Pureed diet : level 4

Meal Suggestions
Breakfast	· Ready Brek or powdered porridge. · Thick yoghurt. · Pureed fruit. · Pureed scrambled or poached egg (try with pureed avocado). · Pureed smoked haddock – blended with butter, cream or milk. · Pureed halwa (no puri).
Main Meals	· Pureed pasta with sauce e.g. macaroni, ravioli,            Bolognese. · Pureed curry (meat/vegetable/lentil) with a thick sauce. · Pureed casserole/stew with a thick sauce e.g. bigos/gulasz/nihari. · Pureed khichdi. · Pureed dahl. · Pureed sausages (skins removed) with a thick gravy. · Pureed fish pie with a thick sauce. · Pureed broccoli/cauliflower with cheese sauce. · Pureed cottage/shepherd’s pie. · Pureed ratatouille. · Pureed chilli con carne.   Meals can be served with smooth potatoes – can add cheese, butter, cream, gravy, cream/soft cheese. All  meals can be served with pureed vegetables, e.g. carrot, swede, broccoli, parsnips, cauliflower.

Pureed diet : level 4

Meal Suggestions
Desserts	· Smooth yoghurt (no bits). · Mousse. · Custard. · Instant whip. · Pureed fruit (no skins, seeds or pips). · Panna cotta. · Cheesecake (without biscuit base). · Tiramisu. · Pureed kheer.
Snacks	· Smoothie (no bits). · Cheese spread. · Smooth paté. · Smooth thick soup (no bits). · Smooth/pureed avocado. · Hummus. · Pureed tinned spaghetti. · Pureed egg mayonnaise. · Thick lassi (no froth). · Pureed ryz z jabłkami.

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 pureeing.

• Add double cream to foods before pureeing 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 pureeing 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 these 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/

Other providers are available

USEFUL CONTACTS

SPEECH AND LANGUAGE THERAPY

Acute adult—Worcestershire Acute Hospitals NHS Trust

Covering the Alexandra Hospital, Redditch and Worcester Royal Hospital.

Telephone: 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.

Telephone: 01905 681 049

DIETITIAN

Acute service—Worcestershire Acute Hospitals NHS Trust

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

Telephone: 01905 760 136

Email: [email protected]

Community Dietitian —Worcestershire Health and Care NHS Trust

Telephone: 0300 123 8098

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

Updated: June 2026

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