You may be having difficulty in eating, drinking and swallowing. The medical term for this is “dysphagia”.

Dysphagia can occur for many reasons, for example as a result of stroke, multiple sclerosis (MS), motor neurone disease, Parkinson’s disease, dementia, developmental disorders, head trauma or head and neck surgery.

This can make having an adequate and nourishing diet difficult. As a result weight loss, dehydration, weakness, depression, nutritional deficiencies and a reduced ability to fight off infection can occur.

The speech and language therapist will assess and diagnose any eating, drinking and swallowing problems you may have. They will then recommend the safest consistencies of food and drink and any strategies that may help. This will ensure that eating and drinking can be as safe, enjoyable and comfortable as possible.

Follow your speech and language therapist’s guidance. If you have any questions, please ask for advice.

The dietitian will advise on a suitable nutritionally adequate diet for you and give you practical advice on how to continue the diet at home.

Easy to chew food may be used if you have strong enough chewing ability to manage soft / tender foods. This texture may be right for you if you usually choose to eat soft food, have weaker chewing muscles or can chew softer foods without tiring easily. It may be a good choice if you have been ill and are recovering strength.

In this information we cover:

• what is an easy to chew diet?
• how do I test my food to make sure it is easy to chew?
• which foods should not be included in an easy to chew diet?
• which foods can be included in an easy to chew diet?
• sample meal plan
• ready meals
• getting the right balance
• food fortification.

What is an easy to chew diet?

An easy to chew diet consists of normal, ‘everyday foods’ of soft, tender texture.

• Pieces of food may be a range of sizes.
• You should be able to bite off pieces of soft and tender food.

How do I test my food to make sure it is easy to chew?

Must be able to break food apart easily with the side of a fork or spoon. To make sure the food is soft enough, press down on the fork until the thumbnail blanches to white, then lift the fork to see that the food is completely squashed and does not regain its shape.

Easy to chew foods must break apart easily and pass the fork pressure test.

Which foods should not be included in an easy to chew diet?

• Hard or dry foods, for example nuts, raw vegetables (such as carrot, cauliflower or broccoli), dry cakes, dry bread or dry cereals.
• Tough, stringy or fibrous foods, including steak, rhubarb, beans, celery or pineapple.
• Chewy foods, for example lollies, toffees, sweets, chunks of cheese, marshmallows, chewing gum or dried fruit.
• Crispy foods, such as crackling, crisp bacon or cornflakes.
• Crunchy foods, for example raw carrot, raw apple and popcorn.
• Sharp or spiky foods, such as tortilla chips or crisps.
• Pips and seeds, including apple seeds, pumpkin seeds and orange pith.
• Bone or gristle, such as chicken, fish or other bones and meat with gristle.
• Sticky foods, including overcooked porridge or sticky mashed potato.

Which foods can be included in an easy to chew diet?

It is important to eat as wide a variety of foods as possible, and to choose foods from each of the groups below.

Starchy foods

Aim to include at least one starchy food at each meal.

• Cereal should have a soft texture with any excess liquid drained before serving. Porridge (use fine-grain oats) and other instant cereals like Ready Brek or Oats-So-Simple. Other breakfast cereals such as Weetabix or cornflakes soaked in milk. Avoid cereals with added nuts and dried fruit, such as muesli.
• Potatoes should be cooked until soft enough to be broken apart with the side of a fork or spoon.
• Bread with butter or margarine (remove crusts and avoid newly baked bread). Some people find that bread is difficult to swallow. Sandwiches are suitable for this diet as long as the fillings are soft and tender, for example egg mayonnaise, paté or cream cheese.
• Well cooked pasta, such as macaroni cheese, ravioli, lasagne and spaghetti bolognaise.
• Rice does not have any special cooking requirements.
• Cake or sponge, Eve’s pudding, chocolate Swiss roll. Avoid pieces of nut.
• Soft biscuits, including wafers, soft macaroons and jaffa cakes.

Fruits and vegetables

Aim to have five portions each day, one of which could be a glass of pure fruit juice or a smoothie.

• Fruit should be ripe and soft enough to break apart into smaller pieces with the side of a fork or spoon. Any excess liquid should be drained. Ideas include bananas, strawberries, raspberries or ripe avocado. Tinned fruit is suitable but avoid skins, stones and pips. You could also try stewed fruit, such as apples, pears or rhubarb, but remove skins first.
• Do not use the fibrous parts of fruit, for example the white parts of an orange.
• Be careful when eating fruit with a high-water content, where the juice separates from the solid in the mouth during chewing, for example melon, oranges or grapefruit.
• Vegetables should be steamed or boiled until tender and soft enough to be broken apart with the side of a fork or spoon, including swede, broccoli, cauliflower or carrots.
• Tinned tomatoes, creamed sweetcorn and mushy peas are suitable.
• Stir fried vegetables may be too firm to be easy to chew.

Meat, poultry, fish, eggs and pulses

Aim to include two portions a day.

• Meat and poultry should be cooked until tender. If this is not possible meat and poultry should be finely minced or chopped to a 4mm lump size. Good examples include shepherd’s pie, pasta dishes with a meat sauce, meat loaf, chicken supreme, corned beef hash, tender casserole, tender meat or chicken curry, tender roast meat and soft skinless sausage. Tinned meat or poultry are also suitable, for example chicken in white sauce.
• Fish should be boneless and cooked until soft enough to break apart easily with the side of a fork or spoon. Avoid batter and crumb coatings. Try tinned fish, for example salmon or tuna or fish pie but make sure bones are removed. Fish cakes are suitable.
• Eggs are suitable, including poached, scrambled, fried, omelette. Hard boiled eggs mashed with mayonnaise are suitable. Avoid scotch eggs.
• Beans and lentils can be included in thick soups, stews and casseroles (with or without meat). Baked beans are suitable.
• Smooth houmous and taramasalata.
• Tofu, Quorn and textured vegetable protein should be minced or cut into small manageable pieces

Milk and milk products

Try to have a pint of milk every day, or include two to three servings of milk products.

• Milk can be used in drinks and as the base for many sauces.
• Milk puddings are ideal.
• Yoghurt, custard, trifle and fromage frais make good desserts (avoid those with nuts, seeds and grains).
• Try adding evaporated or condensed milk to fruit, puddings and sauces.
• Grated cheese can be added to mashed potato, pureed soup, white sauce, cauliflower cheese. Eating a chunk of hard cheese is not recommended.
• Ice cream is not suitable for everyone with a swallowing difficulty, please ask your speech and language therapist for advice.
• Homemade, tinned or packet milk puddings, including custard, semolina, and rice pudding, Instant Whip, Angel Delight and crème caramel.

Sample menu plan

Breakfast

Fruit or juice

Weetabix and milk

Tea

Mid-morning         

Milky coffee/drink

Sponge cake or jaffa cakes

Lunch

Soup

Pasta with bolognese sauce

Mashed jacket potato (skin removed) with tuna mayonnaise or grated cheese

Stewed apples with custard 

Mid-afternoon

Milkshake

Wafer biscuits

Evening meal       

Glass of fruit juice

Lamb or meat casserole with gravy and soft cooked vegetables

Bed-time     

Malted milk drink

Ready meals

Supermarkets now sell a wide variety of ready meals, some of which may be suitable for an easy to chew diet. For example:

• cottage or shepherd’s pie
• fisherman’s pie (remove any bones first)
• corned beef hash
• cheddar cheese and onion mash
• pasta dishes such as lasagne, spaghetti bolognese and macaroni cheese
• cauliflower cheese
• casserole or hot pots.

Sauces can be made from granules or bought ready prepared.

Delivered meals

Meals on wheels can provide a meal on request, however you may need to request or add additional gravy or sauce.

Wiltshire Farm foods have an extra tender range which might be suitable.

Getting the right balance

If you choose a variety of foods from each of the five food groups, as shown, you should be having a balanced diet. However, it is sometimes more difficult to achieve this on an easy to chew. Here are a few tips.

Energy (calories)

If you are having difficulty maintaining your weight, please read the section on food fortification to boost the energy and nutrient content of your diet.

Constipation

Constipation may be a problem because you are lacking fibre in your diet. Introduce more fibre slowly into your diet to let your body adapt.  Good sources of fibre are:

• breakfast cereals such as porridge and instant hot oat cereals or Weetabix.
• fruits and vegetables – try to have the recommended five portions a day. Prunes and prune juice may be helpful.
• pulses such as beans – all pulses are high in fibre.

Over-the-counter fibre supplements are available. Your GP can prescribe other fibre supplements.

Fluid is essential to help the fibre to work, and to prevent dehydration ensuring your skin retains its elasticity and your kidneys function properly. You should aim for at least six to eight drinks a day, include a variety of tea, coffee, squash, juice, water, milk, milkshakes, malted “bedtime” drinks.

Vitamin C

Having five portions of fruit and vegetables a day will help, try to include a rich source of vitamin C such as:

• Ribena, C-Vit, supermarkets own fortified blackcurrant squash and rose-hip syrup
• pureed fruit such as strawberries or kiwis.

Iron

Meat is a good source of iron. If you are still finding meat especially difficult to swallow, please ask the dietitian for ideas. Other good sources include egg yolk, breakfast cereals, pulses and dark green leafy vegetables. A glass of fruit juice taken with a meal will help your body to absorb the iron.

Food fortification

Food fortification is a way of boosting the amount of nutrients in your food.

Having a good nutritional intake will help you:

• regain lost weight or maintain your current weight
• maintain your muscles and keep your skin healthy
• feel healthier and have more energy.

How to fortify your food

Skimmed milk powder

• Add two to four tablespoons to a pint of full fat milk and use whenever you take milk. Add one tablespoon to porridge, soups, mashed potato etc.

Cheese

• Add grated cheese to cooked vegetables, potatoes, soup, pasta and sauces.

Yoghurt and fromage frais

• Choose thick and creamy, full fat varieties or Greek yoghurt.

Butter, margarine and oil

• Use full fat spreads added generously on all foods.
• Fry foods such as onions, vegetables and meat.
• Use oil-based dressings generously, you could add to hot potatoes or pasta.
• Mayonnaise and salad cream can be added to food.

Cream

• Add to soups, sauces, custard and milk puddings.
• Add to porridge.
• Serve whipped or clotted cream with mousse or fruit.
• Add to milky drinks and coffee.

Sugar and sugary foods

• If you have diabetes check with your healthcare professional first.
• Add sugar to drinks, cereals and desserts.
• Use ordinary fizzy drinks and squashes, rather than low calorie or sugar free.
• Add seedless jam, honey or syrup to fruit or puddings.

General hints to improve intake

• Make sure that all your food is served at the correct texture and consistency suited to your swallowing and chewing ability.
• Remember that tiredness may affect your food intake and your swallowing ability.
• Try to eat little and often, aim for three small meals and two to three snacks.
• Have nourishing drinks between meals, such as milk, Horlicks, hot chocolate or Ovaltine. Follow your speech and language therapist’s advice about drinks.
• Try to have a portion of meat/fish (or alternative) at each main meal.
• Use full fat products, including full fat milk, thick and creamy yoghurts and full fat cheese.
• It is a good idea, if you are able, to check and record your weight regularly (every two to four weeks).
• Speak to your dietitian or speech and language therapist if you are unsure of anything.

Alcohol

In small amounts alcohol can stimulate your appetite, such as sherry or an aperitif. Please check that alcohol will not react with any medications you are taking. Follow your speech and language therapist’s advice about drinks.

Oral nutritional supplements

If you are not managing to eat and drink enough to meet your protein and calorie requirements your healthcare professional may recommend an oral nutritional supplement. These are specialist products, usually drinks or puddings that contain increased levels of nutrition. They should be taken in addition to your normal meals and snacks.

Get in touch

Contact our Nutrition and Dietetics or Adult Speech and Language Therapy Service, using the details below.