Chewing and Swallowing Difficulties
If you or a loved one are having trouble chewing and/or swallowing, you may benefit from changing the consistency of your food and trying either a mechanical soft or a puree diet.
A mechanical soft diet requires some chewing ability. Food should be moist and cooked to a fork-mashable texture. Meat should either be ground or minced. Covering the meat with gravy may help. Bread products, crackers and other dry foods may be difficult to swallow and a good substitution can be pasta with sauce.
A puree diet requires minimal chewing. Food should be processed in a food processor until it is smooth and pudding-like. It should contain no small particles or chunks which could make swallowing much more difficult. As you will see below, adding small amounts of water, milk, broth or other fluids to the food being pureed can not only make the process quicker but can yield a smoother product. Peanut butter should always be mixed with other items when pureed and should never be eaten alone as it is a choking hazard for those with swallowing difficulties. Some items puree better than others. For example, cooked sweet potatoes puree better than regular potatoes, and cooked carrots puree well but corn does not. Here are some suggestions:
- Regular cooked cream of wheat or grits - no need to puree.
- Fruit - some fruits become very wet when pureed and require the addition of a stabilizer. Unflavored gelatin works well for this. Add a bit of lemon juice and sugar to pureed bananas to reduce discoloration.
- Coffee cake, danish or donut - add 1 tablespoon milk or more to reach desired consistency.
- Hardboiled egg and toast – puree one egg with 2 tablespoon milk, one slice of toast and 1 teaspoon of butter until completely smooth.
Lunch and dinner ideas:
- Casseroles - puree freshly cooked casserole and add gravy or broth to achieve the desired consistency.
- Meat - add a stabilizer like bread, mashed potato flakes or fat to help produce a smoother product.
- Vegetables - cook raw and frozen vegetables first. Puree and add butter or a stabilizer as needed.
- Fruit - Some fruits become very wet when pureed and require the addition of a stabilizer. Unflavored gelatin works well for this.
- Peanut butter and jelly sandwich - Puree 2 slices of bread, 3 tablespoons creamy peanut butter, 2 tablespoons seedless jelly and 3 tablespoons milk or more to obtain desired consistency.
- Smooth cream soups.
- Snack ideas - pureed cottage cheese, pudding, apple sauce, yogurt.
- Desserts - Dutch apple pie - puree one slice of pie with 3 tablespoons milk until desired consistency. Cupcakes - puree cupcake with 2 tablespoons milk. Frosted Brownie - puree brownie square with 1 ½ tablespoons milk or more to reach desired consistency.
Thickened Liquids: Staying properly hydrated can be a problem for those with swallowing difficulties. Thin liquids can be especially difficult to swallow and can cause choking. You may benefit from thickened liquids which move slower through the mouth and esophagus. There are a few different consistencies of thickened liquids which include: nectar-like, honey-like and spoon thick. These can be either purchased ready to drink or as a powdered thickener (like Thick It or ThickenUp), which can be added to regular thin liquids to create the best thickness for you. There are also some naturally thickened nectar-like beverages which include: apricot, pear or peach nectars, buttermilk, drinkable yogurt and eggnog.
Some additional things to consider:
- Your body position is important when it comes to swallowing. It is easiest to swallow when the chin is positioned at a 90 degree angle to the torso. Tuck your chin toward your chest slightly when you swallow. Remain upright after eating for at least 30 minutes.
- Use of cold foods or liquids at the beginning of the meal (such as lemon ice) or interspersed during the meal to stimulate the nerves to assist with swallowing may be helpful.
- Alternating liquids and solids may be helpful.
- Always use safe food handling techniques.
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