Home Health & Hospice

Nutrition plans for patients with swallowing disorders

Homecare Insider, March 18, 2013

Patients with swallowing problems should have a diet recommendation in the treatment plan. The SLP (speech therapist) will recommend the diet that will be easiest and safest for the patient. The diet for a patient with swallowing problems will most likely be based on the National Dysphagia Diet Task Force definitions. This makes it easier for everyone to know what foods the patient should (and should not) eat.

  • Level 1: Dysphagia pureed. Pureed food is as thick as pudding. It should not be watery or runny (remember that liquids are harder to swallow). Test this by placing a plastic spoon in the food. The spoon should stand upright if the food is pudding consistency. The food should not contain chunks but be smooth. Examples: mashed potatoes with gravy, cream of wheat, yogurt, and pudding. Do not offer the patient any food that has to be chewed or moved around in the mouth. Dry bread should not be offered, even though the bread seems to be soft enough that it might “melt” in the mouth, since it would have to be moved about by the tongue.
  • Level 2: Dysphagia mechanically altered. The “mechanical” part of this definition refers to chopping, mincing, or grinding the food. Foods at this level are moist and stick together. Meat can be offered if it is ground to pieces that are one-quarter inch or smaller (about the size of a small pea). Examples: cooked oatmeal, hamburger with gravy, eggs, and soft-cooked vegetables mashed with a fork. Do not offer crackers, bread, hard cookies, or other dry food.
  • Level 3: Dysphagia advanced. The advanced level is for patients who can chew and have a less severe swallowing problem. Examples: tender meat, cooked vegetables, rice, shredded lettuce, peeled fruit, and moist bread. Do not offer hard, sticky, or crunchy food. Very dry food should also be avoided.

The key to safe food for the patient with swallowing problems is to keep it moist. Dry food is hard to chew and swallow. Gravy and sauces make food moist as well as hold it together. This is important for the patient who has trouble forming a ball of food on the tongue. Adding gravy, sauce, or a condiment can also make the food more flavorful and appealing to the patient.

This is an excerpt from Beacon Health’s book Home Health Aide On-the-Go In-service Series, Volume XI. Learn more about this valuable resource today!