Soft & Bite-sized – Level 6

Soft & Bite-sized – Level 6

SOFT & BITE-SIZED

 Level 6

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 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 have recommended you have soft & bite-sized 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 to 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 6) 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 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. 

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.

 Soft and bite-sized diet : level 6

Does not include bread products.  
Food is soft, moist and tender. 
 
Can be eaten with a fork, spoon or chopsticks.
 
Must be cut no larger than 1.5cm x 1.5cm pieces. 
 
Fish must break up into small pieces with a fork.
 
Food should be soft enough so that it can be broken up easily with a fork and does not return to its original shape when pushed with a fork.
 
Needs some chewing. 
 
Does not require biting.
 
Does not need to be cut with a knife.
 
Liquid should not separate.

Fork Pressure Test:

To make sure the food is soft enough, press down with a fork (see below), then lift the fork to check that the food is completely squashed and does not regain its shape.

How to prepare soft and bite-sized food:

• Choose foods without skins, for example, chicken fillets, skinless sausages or sausage meat.

• Cook well until tender.

• Add a liquid like milk, juice, sauce, stock or gravy (not water as it dilutes the taste and goodness in the food) as required.

• Check that foods haven’t thinned out and any liquid within the food has not separated out.

• Cut into bite sized pieces. No bigger than 1.5 cm.

How to present soft and bite-sized food:

Prepare each food item separately and keep them separate on the plate.

Alternatively, pre-prepared food can be purchased from some suppliers such as those listed on page 11.

Soft and bite-sized diet : level 6

Meal Suggestions
Breakfast	· Ready Brek, porridge halwa (without puri). · Weetabix (ensure it is well soaked in milk but no excess fluid). · Thick yoghurt. · Soft/chopped/stewed fruit. · Eggs: scrambled, boiled, poached, omelette. · Smoked haddock with plenty of butter.
Main Meals	· Pasta with sauce e.g. macaroni cheese, ravioli, Bolognese. · Well cooked lentil/vegetable or mince curry with sauce (no rice). · Dahl. · Shepherd’s/cottage pie. Corned beef hash. · Fish: poached with sauce or in a pie. · Well cooked broccoli/cauliflower with cheese sauce. · Chilli con carne (no rice) – made with meat/Quorn/soya mince. · Stew/casserole: any meat or poultry which has been slow cooked and is very tender, with a thick gravy or sauce, e.g. bigos, gulasz, nihari. · Khichdi. · Potatoes: mashed, soft boiled, jacket – (without the skin), try serving with tuna mayonnaise/chilli/cheese. · Eggs: omelette, poached, scrambled, boiled. Serve all meals with well cooked/soft vegetables e.g. carrots, swede, broccoli, parsnips, cauliflower.

Soft and bite-sized diet : level 6

Meal Suggestions
Desserts	· Yoghurt, mousse, custard, instant whip. · Panna cotta. Tiramisu. Crème caramel. · Soft fruit (no skins, seeds or pips): e.g. banana, peaches, pears. · Smoothie. · Soft sponge cake with custard/ cream.  · Trifle. · Rice pudding. · Kheer cooked until soft and rice grains not whole.
Snacks	· Soft cheese, cottage cheese, cheese spread. · Paté. · Egg/tuna mayonnaise. · Hummus. · Avocado. · Tinned spaghetti. · Soft melting crisps (Quavers, Wotsits, Skips). · Banana. · Mashed avocado with scrambled eggs. · Lassi. · Ryz z jabłkami.

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 · Ginger · Nutmeg

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 the nutritional content to help 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.

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

• Add honey/jam/sugar/syrup to foods.

• Add butter/spread or oil such as olive/rapeseed oil to foods 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 (eg. 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 regarding this.

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 adults—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

Tel No: 0300 123 8098

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

Updated: June 2026

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