Information Prescriptions

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information about your condition and local services.
www.nhs.uk/ips

How can I help reduce healthcare associated

infections?
Infection control is important to the well-being of our patients
and for that reason we have infection control procedures in
place. Keeping your hands clean is an effective way of
preventing the spread of infections. We ask that you, and
anyone visiting you, use the hand rub (special gel) available
at the main entrance of the hospital and at the entrance to
every ward before coming in to and after leaving the ward or
hospital. In some situations hands may need to be washed
at the sink using soap and water rather than using the hand
rub. Staff will let you know if this is the case.
Puree Diet
www.buckshealthcare.nhs.uk

If you require an interpreter or need a document in another

language, large print, Braille or audio version please ask for
assistance.
Produced by:
Department of Nutrition & Dietetics
Buckinghamshire Healthcare NHS Trust.
Amersham Hospital: Tel: 01494 734704 Patient Information Leaflet
Stoke Mandeville Hospital: Tel: 01296 315775
Wycombe Hospital: Tel: 01494 425776

Author: Macmillan Dietitians Leaflet code: CISS-112

Issue date: January 2012 Version: 4
Reviewed: May 2018
Review date: May 2020
 Introduction
Your Plan
You have been given this leaflet because you or the person you are
caring for has been having problems swallowing food or drinks. This …………………………………………………………………………..
is called ‘dysphagia’.
…………………………………………………………………………..
What is dysphagia?
Dysphagia can be one or more of the following: …………………………………………………………………………..
• Finding it hard to swallow food or drinks
• Finding it hard to keep food and drinks in the mouth …………………………………………………………………………..
• Finding it hard to chew food
• Finding food left in your mouth after eating …………………………………………………………………………..
• Food or drink ‘going down the wrong way’ making you cough
…………………………………………………………………………..
Food or drink that ‘goes down the wrong way’ can cause chest
infections which can be very serious. …………………………………………………………………………..

Some people who have dysphagia do not choke on food or drink …………………………………………………………………………..
even if it ‘goes down the wrong way’. This is not always a good
sign because it means that food or drink can ‘go down the wrong …………………………………………………………………………..
way’ without the person even being aware of it.
…………………………………………………………………………..
This is why it is very important to follow the advice that you have
been given in this leaflet.

If you notice any of the following contact your speech and language
therapist (SLT) or re-refer yourself to a speech and language Ready Prepared Meals
therapist: If preparing pureed meals is difficult for you or your
• Coughing or choking when eating or drinking carer, you could try pureed ready prepared meals
• Gurgly, wet voice after eating or drinking delivered to your door e.g.
• Food staying in the mouth after eating  Mrs Gills Kitchen (020 8807 6584) mrgills.co.uk
• Regular chest infections e.g. every 6 -10 weeks throughout the  Oakhouse Foods (0333 370 6700)
year oakhousefoods.co.uk/pureed-ready-meals.html
• Unplanned weight loss  Wiltshire Farm Foods (0800 077 3100)
wiltshirefarmfoods.com/ready-meals/puree-classic
This leaflet has been designed to 1help you choose foods that can
make your swallowing easier and safer. 12
 What is a pureed diet?
Questions you might have
Pureed food:
Can I use baby foods?
• Is smooth and contains no bits e.g. lumps, seeds,
Baby foods are not designed for adults and therefore
skins, husks, fibres, gristle, bone
will not give your body all the nutrients it needs. Baby
• Holds its shape on a plate, and the prongs of a fork
foods also tend to be quite bland which does not suit
will make a mark on the foods surface
adult tastes. They are not advised for people with
• Can be eaten with a fork because it does not drop
dysphagia.
through the prongs
• Cannot be poured
What about mouth care?
• Does not spread out if spilled
Chewing helps produce saliva which keeps the mouth
• Does not require chewing
healthy. Cleaning your mouth and teeth regularly is
very important because you chew less when eating a
How to make pureed food
pureed diet, so you produce less saliva.
• To obtain the right consistency you will need either
a liquidiser, a food processor or a hand blender.

• Before pureeing remove skins, large seeds, bones

What about fluids? (e.g. in fish).

You may have been advised by a Speech and Language • Meats, vegetables and potatoes should be well
Therapist (SLT) to drink only Thickened Fluids in addition to
Puree food. Follow this advice closely to avoid risk of
cooked and tender before pureeing - try stewing or
aspiration, and make sure that you drink plenty (1.5 to 2 casseroling.
litres/ day) to stay hydrated.
• Some foods may also need to be sieved after
pureeing to remove bits such as skins.

You may need to add extra liquid to some food to

ensure you obtain the correct texture but be careful not
to add too much (see What is a pureed diet? above).

11 2
It is important to use a high calorie liquid such as:
Starchy carbohydrate foods
• Full fat milk or Fortified milk (see page 5 for
recipe) Type of food Suitable texture Suitable to May be suitable Unsuitable to
• Cheese sauce, white sauce, parsley sauce, already - no need purée to purée
to puree purée
bread sauce POTATOES Instant mashed Mashed potato Potato salad Potatoes in their
• Gravy potato
Boiled potatoes
(skinless potato skins
and mayonnaise
• Custard (no skins) only) Roast potatoes

• Fruit juice (avoid those labelled diet, sugar free Inside of jacket
potato
Chips
Potato croquettes
and no added sugar)
Other fried
potatoes
For more advice see Fortifying food (page 5).
PASTA Tinned macaroni Homemade Pasta salad
cheese pasta dishes e.g.
Do not use water because this will dilute the foods spaghetti Al denté pasta
Tinned pasta in bolognese (well
calories and flavour. tomato sauce cooked pasta
Filled pasta

Tinned ravioli with smooth Pasta ready-meals

sauce)
Chinese style
Making pureed food look and taste nice Well cooked
noodles
pasta with a
• Puree foods separately to retain flavours, and smooth sauce
arrange the purees individually on the plate.
• Try to serve brightly coloured vegetables next to RICE Boiled rice

paler foods e.g. pureed carrots or broccoli with Rice salad

pureed potato and pureed chicken in a creamy Fried rice

sauce. Savoury rice

• Try adding more flavour when pureeing food to BREAD Soft All other bread
breadcrumbs
make eating more enjoyable e.g. try using added to soup Sandwiches

spices, herbs, soy sauce, Worcester sauce, BREAKFAST Porridge All other breakfast
tomato sauce, barbecue sauce, curry sauce or CEREALS
Ready Brek
cereals

mint jelly. Well soaked

• Pureed food can be piped or scooped to make it Weetabix

look more appealing.

3 10
 Fruit and Vegetables
Nutrition
Type of Suitable Suitable to May be suitable to Unsuitable to
food texture
already - no
purée purée purée If you need to eat a pureed diet, it can be hard to
need to puree meet all your nutritional needs and it is important to
VEGETABL Peeled and well All the following Salad vegetables
ES cooked root must be sieved to e.g. tomatoes, choose a wide variety of foods.
vegetables such as: remove skins, cucumber,
carrot, seeds, ‘strings’ etc. radishes, lettuce,
swede,
turnip, peas,
celery etc Eat little and often – e.g. 3 small meals and 2-3
beans, Raw vegetables
parsnip,
sweetcorn,
snacks and try to have the following every day:
sweet potato,
yam asparagus,
courgettes,
Lightly cooked
vegetables • 3 portions of full fat milk or milk containing
Well cooked marrow, Mushrooms foods (e.g. cheese in a pureed meal, thick
broccoli and leafy veg such as
cauliflower cabbage, greens, Onion and creamy yoghurt (may need to be
spinach, sprouts.
Peeled and well Leeks sieved to remove fruit pieces)
cooked pumpkin
and squash
Well cooked
plantain (not fried)
Peppers • 3 portions of meat, chicken, fish, eggs,
Avocado Dhal/lentils
Prepared salads
e.g coleslaw
quorn, soya, lentils or beans (these may
Baked beans
Ratatouille
need to be pushed through a sieve to
FRUIT Banana Melon (may need Dried fruit remove skins)
thickening)
Peeled and
stewed - apple, Strawberries, kiwi
All other fruit • 3 portions of potatoes, pasta or cereal
pear, peach fruit, mango, • 5 portions of fruit and vegetables
watermelon (must
Tinned pears, be sieved, and • At least 6 – 8 mugs or glasses of fluid – you
peaches, mango may need
thickening)
may need to thicken your drinks and your
All the following SLT will advise you about this.
must be sieved: • You may be advised to choose nourishing
stewed or tinned -
rhubarb,
drinks (e.g. fruit juice; smoothies; milky
plums,
blackcurrants,
drinks such as hot chocolate, milky coffee,
raspberries, milkshakes, yoghurt drinks, malted drinks
cherries,
apricots, (Ovaltine, Horlicks) – all these can be made
gooseberries,
prunes,
with fortified milk – see Fortifying food)
strawberries

9 4
 Fortifying food
Nutrition
This is a way of increasing the nutrient and energy
If you need to eat a pureed diet, it can be hard to meet
content of your food and drink without increasing your
all your nutritional needs and it is important to choose a
portion sizes.
wide variety of foods.
Fortifying foods can make it easier for you to eat enough
Eat little and often – e.g. 3 small meals and 2-3 snacks
calories and protein every day.
and try to have the following every day:
• 3 portions of full fat milk or milk containing
Fortified milk - Add 4 tablespoons of dried skimmed milk
foods (e.g. cheese in a pureed meal, thick and
powder to each pint of full fat milk and use this as you
creamy yoghurt (may need to be sieved to
would use normal milk (e.g. in drinks, porridge, custard)
remove fruit pieces)
• 3 portions of meat, chicken, fish, eggs, quorn,
To savoury foods - add cheese, fortified milk, dried
soya, lentils or beans (these may need to be
skimmed milk powder, gravy, cream, crème frâiche, or
pushed through a sieve to remove skins)
butter/margarine (avoid low fat spread)
• 3 portions of potatoes, pasta or cereal
For example:
• 5 portions of fruit and vegetables
to thick, smooth soups add grated cheese, dried
• At least 6 – 8 mugs or glasses of fluid – you
skimmed milk powder, evaporated milk, cream. Try
may need to thicken your drinks and your SLT
making cuppa soup with fortified milk instead of water.
will advise you about this.
(If you need to thicken drinks, soups will need to be
• You may be advised to choose nourishing
thickened too).
drinks (e.g. fruit juice; smoothies; milky drinks
to sauces add evaporated milk, full fat natural yoghurt,
such as hot chocolate, milky coffee,
grated cheese, smooth nut butter, butter or margarine
milkshakes, yoghurt drinks, malted drinks
cream
(Ovaltine, Horlicks) – all these can be made
to mashed potato add grated cheese, full fat mayonnaise
with fortified milk – see Fortifying food)
or salad cream, milk based sauces, cream, butter or
margarine (avoid low fat spread) or olive oil
to vegetables add grated cheese, full fat natural yoghurt,
full fat mayonnaise, butter, margarine (avoid low fat
5 spread) or olive oil. 8
 Other foods Which foods are suitable for Puree? Not all foods can
be pureed to produce a safe texture – please use the
Type of food Suitable texture Suitable to May be suitable to Unsuitable to tables below as a guide
already - no purée purée purée
Type of Suitable texture Suitable to May be suitable to Unsuitable to
need to puree
food already - no need purée purée purée
SOUPS Smooth soups ‘Bitty’/chunky
to puree
(may need soups
MEAT Smooth meat paste Tender, well cooked Sausage meat Tough meats
thickening)
beef, lamb, pork,
PASTRY Soft pastry as part of Crisp pastry Smooth paté chicken, turkey Sausages (skins Sausage skins
suitable meat/ fruit (skin removed from removed)
pie Bacon
chicken and turkey) Meat pies (must be
PIZZA All pizzas Breadcrumbed/
tender meat in gravy
and soft pastry*) battered meats
CRISPS/ All crisps/ Burgers
Tender stews or
SAVOURY
savoury snacks casseroles* Chilli con carne
SNACKS
Curries *
CAKES/ Semolina Tapioca Plain rice pudding Jelly
Meat pasties
PUDDINGS/ (without dried fruit, Faggots
DESSERTS Ground rice Sago skin etc). Ice cream Sausage rolls
(INCLUDING pudding Shepherds/cottage
Egg custard Plain sponge/ All other cakes,
YOGHURT AND pie
Thick custard (without sponge pudding with puddings and
ICE CREAM) FISH Smooth fish Fish in sauce without Fish with bones
pastry) syrup/ lemon curd/ desserts
Blancmange paste bones
seedless jam/ Battered/
Tiramisu Fruit crumble/ fruit
Crème caramel chocolate sauce Smooth fish pate Tinned tuna/ salmon - breadcrumbed
pie
Junket pureed with custard/ bones removed fish
Angel Delight/ Taramasalata
cream
Instant Whip Pannacotta Tinned fish in tomato Shellfish
Custard tart (soft sauce -bones removed
Smooth mousse Squid
pastry) Crab
Smooth EGGS Egg mayonnaise Quiche
Fruit fool (no seeds)
yoghurt/
fromage frais Stewed fruit (suitable Scrambled egg Omelette
fruit)
Cheesecake Fried egg
(without base or Fruit yoghurt/
Poached egg
topping) fromage frais
(sieved) Boiled egg
CHEESE Plain soft cheese Grated cheese very Cheese toppings
Trifle (suitable fruit
(e.g. cream well mixed into hot
only) food only Hard cheese
cheese)
(e.g. cheddar)
BISCUITS Plain biscuits (no All other biscuits Plain cheese
nuts, dried fruit, and crackers spread Soft cheese with
grains, jam, cream ‘bits’
fillings etc) soaked in NUTS Smooth nut butters Crunchy nut
thick liquid butters
Creamed coconut
All other coconut
CONFECTIONERY Discuss with your Speech and Language Therapist
All other nuts
Protein foods
6 *including suitable vegetables only
7