Thickened Drink and Textured/Pureed Food

In the UK the two most commonly prescribed thickeners for drinks (and foods) are Thick & Easy and Resource, although there are others. They are generally powders made of plant-based starches, in some cases with guar or xanthan gum (both plant-based) as well. For thickening most drinks, a set number of scoops per volume of drink should give the stated level of thickness, according to the IDDSI scale above (however, see further below for cases where thickeners don't perform as expected).

A speech and language therapist (salt or slt) will prescribe the most suitable of these thickeners for your particular case, and identify the level of thickness to be used. Do read what the requirements are for the particular level matched to your loved one, and also how to check food and drink before serving it, in the IDDSI Detailed Level Definitions (IDDSI website) and Patient Handout (IDDSI website). The thickener is intended to thicken drinks and foods without affecting their taste or the availability of nutrients to the digestive system, and doesn't provide nutrients or significant calories itself.

Since preparing meals that correctly and always meet the texture requirements is more time-consuming and can benefit from specialised equipment, and creating a variety of meals can be difficult, it's worth noting there are several suppliers of frozen meals for dysphagia. Some of these are microwaveable whilst some are oven-heated, so check which each recipe is. For example, in the UK there's a wide range of meals, including vegetarian ones, from the Oakhouse Foods website. For their pureed, minced & moist, and soft & bite-sized meals (IDDSI levels 4, 5 and 6) see these categories near the bottom of their Go Shopping menu. (We don't receive any money for mentioning this shop.)

These meals can be supplemented by some easy to prepare fruit and snacks, noted below.

Cut a banana into slices and then mash thoroughly with a fork until the whole thing is the same 'wet' consistency.

There is, incidentally, no truth in the rumour that too many bananas are bad for a healthy person, although eating more than two a day is not recommended. Many other fruit and vegetables contain as much potassium as bananas, and in fact the body needs potassium. Someone with kidney problems, however, may receive specific advice on diet. Avoid unripe i.e. green bananas as these may cause constipation.

Apple puree pots are ready-made to a smooth consistency - use the baby food variety as these don't have added sugar (unless advised to have higher energy foods).

Whilst this requires a little preparation you can do a batch and then freeze daily portions to be thawed and microwaved later. Use eating apples and don't add sugar - they taste sweeter cooked than eaten raw. Royal Gala is a good variety to use, as some others like Cox produce so much juice they can bubble over during cooking.

To peel large batches use a peeler machine (one with a curved blade, which can also core and 'spiralise' at the same time - the ones with a wide flat blade don't work for apples that aren't perfectly round and the right size, and could cut you). Then use a normal hand peeler to ensure no parts are missed. If you don't need to puree the apple after cooking, but instead want soft pieces, then you can remove the corer/spiraliser blade from the peeler machine, and then use a separate slicer/corer to remove the core and cut the apple into eight equally sized pieces at the same time.

Whichever method you use, check that the hard hollows around where the pips were have been removed and also that no pips find their way back in. Place in an ovenproof dish with a lid, and cook for approximately one hour at 190 degrees Centigrade (375 degrees Fahrenheit) - adjust the cooking time according to the size of apple and the required texture. It's very important to drain the juice away thoroughly (a sieve is useful). Mash with a fork if required, and allow to cool to eating temperature before serving.

A large batch can be prepared and then frozen in individual portions, but make sure that they're thawed thoroughly before reheating, and that no parts are too hot or too cold.

Pears aren't recommended, as it's difficult to find and remove all the pips (and they can't be peeled by machine).

Be careful, because some describe themselves as smooth but have bits of fruit mixed in or as a layer on top. We also recommend stirring before serving.

A variety of yoghurts are available - look at the nutritional values as some contain more energy than others and this may be something you've been advised on (in either direction).

Obviously ensure that supplies are kept in the fridge, but if your loved one doesn't like them cold straight from the fridge they can be allowed to warm slightly before serving.

Yoghurt is also better than a drink for 'washing down' food that isn't being cleared by coughing and is causing a tickle (but be careful not to give it while coughing is continuous and may result in it being gasped down the wrong way).

Be careful because with starch-based thickener it will thin again over time - so if your loved one takes a long time to eat then mix it up in consecutive small batches they'll eat before it becomes too thin.

Using the powdered form of this dessert mix, with milk, you can adjust the texture. There are standard and no added sugar versions, although as a processed product there are of course lots of added ingredients in both versions.

See the IDDSI Detailed Level Definitions (IDDSI website) and Patient Handout (IDDSI website) for the particular level of food texture matched to your loved one, but for many of the levels beware of:

• shells / skins (sweetcorn, peas, grapes, sausages etc)
• long stringy fibres retained after cooking (leek, rhubarb etc)
• floppy leaves that can cling to the throat (spinach, lettuce etc)
• sticky food (peanut butter, sticky rice etc)
• bits / lumps (fruit pieces in yoghurt, apple pips, seeds in peppers etc)
• runny components (cooking juices, milk in cornflakes etc), including those that run out when chewed (watermelon etc)
• dry / crumbly / crunchy / sharp food (biscuits, cornflakes, crisps in UK English / chips in US English, etc)
• chewy / tough / hard food (toffee, steak, nuts etc)

We've also seen it suggested that even for the higher IDDSI levels that allow discrete food pieces, circular discs such as slices of soft carrot should be avoided by cutting them in two to form semi-circles, as these are less likely to block the airway fully.

Note that liquid versions are available of many common medicines, including paracetamol and some antibiotics, although they may need to be thickened.

Laxatives (such as Laxido and Movicol) simply do not thicken with starch-based thickeners (q.v. the gov.uk website, for 'peg laxatives and starch thickeners'), but there are ready-thickened liquid versions available. You may have to ask your doctor or pharmacist for these.

Multivitamins are also available in liquid form, but do get them from a reputable supplier - for example in the UK Boots sells their own brand and several others. Check with your doctor or qualified pharmacist regarding dosage in your circumstances.