Soft and bite size diet
Read our guide below about a soft and bite size diet for people who have swallowing difficulties.
You can also download a PDF version of this patient information by following the link on the right.
You’ve been given this information because you, or the person you’re caring for has problems swallowing food or drinks. This is called ‘dysphagia’. This information will help you to choose foods that can make your swallowing easier and safer.
What is dysphagia?
If you have dysphagia, you may find it hard to:
- swallow food or drinks
- keep food and drinks in the mouth
- chew food.
You might also have:
- food staying in your mouth after swallowing
- food or drink ‘going down the wrong way’ making you cough or choke.
Food or drink that ‘goes down the wrong way’ may cause a chest infection which can be very serious.
Some people who have dysphagia don’t cough or choke on food or drink when it ‘goes down the wrong way’. This isn’t always a good sign because it means that food or drink can ‘go down the wrong way’ without you being aware of it. You must follow the advice below and from your speech therapist (SLT) or dietitian.
Signs of dysphagia include:
- coughing or choking when eating or drinking
- a gurgly, wet voice after eating or drinking
- food staying in your mouth after swallowing
- regular chest infections, for example, every 6 to 10 weeks throughout the year.
Contact your speech and language therapist or doctor if you notice any of these signs.
What is a soft and bite sized diet?
It’s a diet which involves foods that you don’t need to bite and only need a moderate amount of chewing.
Small pieces of food minimise the choking risk and you can usually eat the food with a fork, spoon or chopsticks. You don’t need a knife to cut the food.
Food is soft, tender and moist, but with no thin liquid leaking/dripping from the food.
Bite-sized’ pieces of food are no more than 1.5 cm x 1.5 cm in size.
Fork pressure test
To test if your food is soft enough, push down on the fork until your thumbnail goes white. Lift the fork to see that the food is completely squashed and doesn’t regain its shape.
Food must pass both the size and softness tests.
High risk foods to avoid
These can be a choking hazard.
Food characteristics to avoid |
Examples of foods to avoid |
| Mixed thin and thick textures | Soup with pieces of food, cereal with milk |
| Hard or dry | Nuts, raw vegetables (for example, carrots, cauliflower, broccoli), dry cakes, bread, dry cereal, pastry (for example, pies and sausage rolls). |
| Tough or fibrous | Steak, pineapple, oranges, apple, grapefruit |
| Chewy | Lollies/candies/sweets, cheese chunks, marshmallows, chewing gum, sticky mashed potato, dried fruits, sticky foods |
| Crispy | Crackling, crisp bacon, cornflakes |
| Crunchy food | Raw carrot, raw apple, popcorn |
| Crisp or spiky | Corn chips and crisps |
| Crumbly bits | Bread, dry cake crumble, dry biscuits (add sauce to make these suitable). |
| Pips, seeds, pith | Apple seeds, pumpkin seeds, white of an orange |
| Food with skins or outer shell | Peas, chicken skin, salmon skin, sausage skin, pulses, chickpeas/butterbeans etc sweetcorn, grapes, berries/currants, cucumber with skin |
| Food with husks | Corn, shredded wheat bran |
| Bone or gristle | Chicken bones, fish bones, other bones, meat with gristle |
| Sticky or gummy food | Nut butter, overcooked oatmeal/porridge, edible gelatin, konjac containing jelly, sticky rice cakes |
| Stringy foods | Beans, rhubarb, celery, lettuce, uncooked spinach leaves, French/green/runner beans |
| Crust formed during cooking or heating | Crust or skin that forms on food during cooking or after heating, for example, cheese topping, mashed potato – this should be removed before eating |
| Juicy food | Where juice separates from the food piece in the mouth, for example watermelon |
| Large or hard lumps of food | Casserole pieces larger than 1.5cm x 1.5cm, fruit, vegetable, meat, pasta or other food pieces larger than 1.5cm x 1.5cm |
Soft and bite sized food
Meat cooked so it’s tender and then chopped so pieces are no bigger than 1.5cm x 1.5cm in size.
Casserole/stew/curry liquid portion (for example, sauce) must be thick (as per clinician recommendations). It can contain meat, fish or vegetables if final cooked pieces are
soft and tender and no larger than 1.5cm x 1.5cm in size.
Fish cooked soft enough to break and serve in pieces no bigger than 1.5cm x 1.5cm. No bones or tough skins.
Fruit soft and chopped in pieces no bigger than 1.5cm x 1.5cm pieces (drain any excess liquid). Don’t use the fibrous part of the fruit. Fruit may need to be stewed or mashed.
Vegetables steamed or boiled with final cooked size no bigger than 1.5cm x 1.5cm. Stir fried vegetables are too firm and not suitable.
Cereal served with pieces no bigger than 1.5cm x 1.5cm, with their texture fully softened. Drain the extra liquid away before serving.
Rice, couscous, quinoa shouldn’t be sticky or gluey and shouldn’t separate into individual grains when served. Needs a sauce to moisten it and hold it together – may need a smooth, thick sauce.
Bread – not regular dry bread, sandwiches or toast of any kind.
Breakfast ideas – all foods cut into small 1.5cm x 1.5cm pieces
- yoghurt based smoothie drink
- overnight oats with frozen fruit/yoghurt
- Greek yoghurt or non-dairy alternative, honey and soft tinned or fresh fruit
- cooked breakfast for example scrambled egg, skinless sausages/ham/Quorn – cut
into small pieces or mashed with fork, cooked mushrooms, tinned tomatoes cut into
small pieces - Weetabix /Oatibix (without dried fruit) with full fat milk and honey or sugar
- instant oats /porridge with full fat milk, or non-dairy alternative and jam or syrup
- soft drained, tinned fruit for example peaches, pears, mandarins
- soft fruits for example bananas, strawberries.
Main course ideas – all foods cut into small 1.5cm x 1.5cm pieces
- minced beef, pork, lamb, chicken, turkey or quorn/meat free mince in gravy
- tender casserole made with small pieces of meat/meat free mince/tofu/quorn
- moist curry with small, tender pieces of chicken, split lentils or vegetables
- dahl
- shepherds/cottage pie topped with mashed potato (remove any crunchy topping) served with extra gravy
- small, very tender pieces of offal, mutton, goat etc with gravy or sauce
- corned beef hash with gravy
- meat balls (cut into bite sized pieces) in gravy or tomato sauce, bolognaise
- soft fish (cut into bite sized pieces –in parsley or cheese sauce (carefully check for bones)
- fish pie with mashed potato topping (remove any crunchy topping – (carefully check for bones)
- moist scrambled egg or mashed boiled or poached egg
- moist risotto including foods of suitable textures
- pasta dishes, for example ravioli, lasagne (remove any crunchy topping)
- macaroni cheese
- potato mashed with cheese or butter
- soft boiled potatoes cut into small pieces in a curry sauce
- tinned spaghetti or ravioli in tomato sauce
- mashed sweet potato, carrots or swede, soft boiled vegetables, for example broccoli, cauliflower, spinach, carrots with white sauce or gravy (cut into small pieces)
- cauliflower cheese with plenty of sauce or cauliflower in a curry sauce
- ratatouille (tomato-based sauce with soft mixed vegetables; for example peppers and courgettes)
- smooth, thick soups.
Cook and serve food with sauces or gravy to help keep them moist.
Dessert ideas – all foods cut into small 1.5cm x 1.5cm pieces
- fruit /plain yoghurts or fromage frais
- stewed fruit with yoghurt, custard, ice-cream or cream
- sponge pudding and custard
- bread and butter pudding with custard, ice-cream or cream
- tapioca, semolina or rice pudding
- potted desserts (avoid those labelled low fat, virtually fat free, low sugar or diet), custard, trifle, rice pudding, mousse, fruit fool, crème caramel
- blancmange, Instant Whip, Angel Delight
- ice cream and jelly (check with your speech and language therapist if these are suitable for you).
Snack ideas – all foods cut into small 1.5cm x 1.5cm pieces
These include:
- pureed sandwiches – see ‘dysphagia meal prep: wrap and sandwich (IDDSI Level 4 pureed)’ on YouTube
- soup* – ensure no bits/lumps/croutons.
- pureed porridge/Ready Brek
- instant whip pudding (for example, Angel Delight)
- mousse
- smoothies* – remove pips/seeds
- milky drinks*
- yogurt/custard/smooth puddings
- savoury dips – taramasalata/hummus/pate
- soft smooth cheese (cut into 1.5cm cubes if solid), for example Boursin, Laughing Cow, feta, Dairylea
- sliced banana (add additional chocolate spread/smooth peanut butter
- moist cake cut to 1.5cm cubes – serve with custard for additional calories
- melt in mouth crisps – wotsits, quavers, skips
- room temperature chocolate buttons/1.5cm sq pieces of light choccolate, for example, Aero/Flake
- ripe fruit cut into small chunks avoidingfibrous fruits for example, pineapple and fruits such as melon/watermelon – can add yogurt, evaporated milk, custard etc for additional calories
- trifle
- rice pudding.
* * We may tell you/your family member that you need thickened fluids. You may need to add thickener to these items for the appropriate thickness.
Nutrition and fluid
On a soft and bite size diet it is important to eat foods from all of the food groups in line with the NHS Eat Well Guide. This will help to make sure you get all the nutrients you need to promote recovery and stay healthy.
Each day include 6 to 8 mugs or glasses of fluid (including all hot and cold drinks) to help support your skin and kidneys and stay hydrated. Do this even if you don’t feel thirsty. Thirst is often a poor indicator of nutritional intake.
Follow the advice of your speech and language therapist if you need to thicken your drinks. Sometimes this is only for a short period of time.
Fortifying food
On a soft and bite size diet, you may need to increase the nutrient and energy content of your food and drink to get enough calories and protein.
If you need to have thickened fluids, you may need to add thickener to drinks/ liquids in addition to the ingredients suggested below.
| Food | Foods to add to increase calories / protein |
| To soups (fresh, tinned, powdered)
To sauces |
Grated cheese, dried skimmed milk powder, evaporated milk, cream, crème fraiche
Full fat yoghurt, cream, grated cheese, smooth nut butter, butter, ghee, oils (you can use different flavours) |
| To vegetables | Grated cheese, full fat natural yoghurt or mayonnaise, butter, ghee or margarine, oils for example, olive, rapeseed, flavoured oils |
| To milk (full fat if possible) | Blend with 3 to 4 tablespoons of skimmed milk powder to make fortified milk. Use this to make hot drinks, flavoured milk, milkshakes and in sauces
|
If you need to have thickened fluids, you may need to add thickener to drinks/ liquids
in addition to ingredients suggested.
Ready prepared meals
If preparing purée meals is difficult for you or your carer, try ready prepared meals delivered to your door from:
About this information
This is intended as general information only. We make the information as up to date and accurate as possible, but it’s subject to change. Check specific advice on any concerns you may have with your doctor.
How can you help reduce healthcare associated infections?
Infection prevention and control is important to the wellbeing of our patients so we have infection prevention and control procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections. Follow our infection prevention and control guidelines when visiting our healthcare sites.