Dietary Advice For a Soft and Bite-Sized Diet

How do I make every bite count?

During your consultation you were asked about your appetite and if you had lost any weight recently. You may have had your weight and height recorded.

This information has identified you as being at risk of malnutrition.  You have also been advised to alter the texture of your diet following a swallow assessment by your Speech and Language Therapist.

It is important to maintain your weight and prevent any or further weight loss to reduce the risk of further health problems and to keep you as well as possible. 

To do this, it is important to eat nourishing foods; high in energy and protein and in line with the recommendations for texture and consistency.

This leaflet gives you ideas about small changes that can be made which will help you achieve a more nourishing diet. This will help prevent further weight loss. 

The following suggestions may help and should be followed until your healthcare professional is happy with your weight or there is a change in the recommended texture of your diet and fluids.

This Leaflet considers the texture of your food only.  If you have been advised to alter the consistency of your fluids then you should follow the recommendations of the Speech and Language Therapist.

When following a soft and bite-sized diet you should choose:

• Foods that can be eaten with a fork, spoon or chopstick.

• Foods that can be mashed or broken down with pressure from a fork, spoon or chopsticks.

• Foods that do not require a knife to be used to cut up food but where a knife may be used to help load the food on to a spoon or fork.

• Foods that need to be chewed to help with swallowing.

• Foods that are tender and moist throughout and which do not separate where a thin liquid forms.

• Foods that are bite-sized (1.5cm sized pieces as a maximum).

Foods that you should avoid:

• Foods with a hard rough texture, for example, dry crackers, biscuits, cereals with dried fruit and nuts including granola or toasted muesli, seeds and crisps.
• Dry or tough meats such as roasted or grilled meat without sauce, meat with gristle.
• Food with bones in fish for example, and stews.
• Dishes with crumb toppings, or hard bases such as pastry, pizza or cakes.
• Casseroles with large pieces of meat.
• Raw vegetables, salads, seeds, nuts and dried fruit and vegetables with skins on, for example, sweetcorn and beans (if necessary).
• Rice or pasta without a sauce.
• Bread unless this has been assessed by the Speech and Language Team.

How do I eat a nourishing diet?

You should try to:

• Eat 3 small meals each day as well as a mid-morning, mid-afternoon and supper time snack or eat small amounts every 2 to 3 hours. 

• Have normal fluids if your able to you should then include nourishing drinks, such as, a glass of milk or a milky drink.

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

• Have plenty of sauces, gravy, custard or cream with your meals.  These will make your food moist and easier to swallow.

Choose nourishing snacks

• Thick and creamy yogurts.
• Porridge or wheat biscuits.
• Scotch pancakes with soft or cream cheese.
• Mousse, jelly blancmange.
• Stewed fruit.

Quick meal ideas

• Fish in a savoury sauce, for example, white, parsley or cheese sauces.

• Soft fish dishes that can be mashed with a fork such as fish pie or soft fish cakes.

• Pasta in a creamy or tomato based sauce, for example, macaroni cheese, spaghetti bolognaise or ravioli.

• Any minced meats, such as mince used in casseroles, stew or curries.

• Soft cooked meats that are diced or can be cut with the side of a fork and served with gravy.

• Corned beef hash.

• Smooth or strained soups, try Cream of Soups or Condensed soups as they are more nutritious. You can also make up packet soups using hot enriched milk.

• Undiluted condensed soups can make a cream base for sauces.

• Inside of a jacket potato (no skin) mixed with butter and fillings such as grated cheese, tuna mayo.

• Egg dishes such as scrambled egg or a plain or cheese omelette.

• Instant hot cereals, for example, Readybrek® made with enriched milk.

• Wheat biscuits served with plenty of enriched milk.

Dessert ideas

• Homemade milk puddings such as, custard, semolina, sago, rice, tapioca, made with enriched milk, evaporated milk or cream. 

• Instant whips, blancmange, milk jellies or mousse made with full cream milk.

• Other cold desserts include crème caramel, egg custard, and individual mini cheese cake.

• Thick and creamy yoghurts and fromage frais, French style set yoghurts.

• Tinned or stewed fruits in syrup with double cream, full fat yogurt, custard or condensed milk.

• Individual sponge puddings and custard.

• You can also add sweet sauces, for example, chocolate, vanilla or lemon.

• Mini individual trifle with 1tbsp double cream.

• Ready to eat rice pudding pot (125g) with 2tbsp of double cream.

• Mashed banana with enriched milk or cream.

Sample menu

Breakfast

Wheat biscuit or pillow (e.g. Weetabix®) or porridge (e.g.Readybrek®) made with full cream milk and with added honey or syrup.

Mid-morning snack

 (see suggestions in leaflet)

Thick and creamy yogurt.

Lunch

Middle of jacket potato with butter and cheese and beans.

Ready to eat rice pudding pot (125g) with 2tbsp of double cream.

Mid-afternoon snack

(See suggestions in leaflet)

Smooth mousse.

Evening meal

Fish in white sauce, mashed potato with added butter, mashed carrot.

Stewed fruit with custard.

Supper

Mashed banana with enriched milk or cream.

Contact numbers

If you need further help or advice, please contact:

North Tees and Hartlepool NHS Foundation Trust

Specialist Services Admin Hub

Telephone: 01429 522471

Opening hours: 8.30am to 4.30pm (Monday to Friday, excluding Bank Holidays).

Information and references used in the development of this leaflet:

1. Food Standards Agency (2002) McCance and Widdowson’s The Composition of Foods, Sixth Summary Edition. Cambridge: Royal Society of Chemistry
2. Gandy, J. (2014). The Manual of Dietetic Practice (5^th Ed). Wiley Blackwell Ltd. 
3. Complete IDDSI Framework Detailed definitions 2.0 | 2019 (http://ftp.iddsi.org/Documents/Complete_IDDSI_Framework_Final_31July2019.pdf)

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]