Advice after your nerve block for surgery
On this page…
What is Soft and Bite-Sized?
You may be advised to have a soft and bite-sized diet if you have problems with your swallowing or oesophagus (‘food-pipe’). Soft and bite-sized foods may be used if you get tired when eating, or have reduced strength for biting and chewing, but are able to chew very soft, moist food that is already cut into small pieces. Soft and bite-sized foods need good tongue control to enable food to be brought together in the mouth for safe swallowing. The pieces are ‘bite-sized’ to reduce choking risk.
Soft and Bite-Sized food
- Is soft, tender and moist, but with no liquid leaking/dripping from the food
- Ability to ‘bite off’ a piece of food is not required
- Ability to chew ‘bite-sized’ pieces so that they are safe to swallow is required
- All food should be cut finely into small bite size pieces no bigger than 1.5cm x 1.5cm
- Food can be mashed/broken down with pressure from a fork
- A knife is not required to cut this food
How to prepare a Soft and Bite-Sized meal
Meat is cooked until tender and chopped so pieces are no bigger than 1.5cm x 1.5cm.
Fish is cooked until soft enough to flake apart and serve in pieces no bigger than 1.5cm x 1.5cm.
Fruit is soft and chopped into pieces no bigger than 1.5cm x 1.5cm. Skins or fibrous parts should be removed. If you have been advised to have thickened fluids you should avoid fruit with high water content, where the juice separates from the solid in the mouth during chewing e.g. watermelon, orange.
Vegetables should be steamed or boiled with final cooked size no bigger than1.5cm x 1.5cm pieces. Stir fried vegetables and salad items are too firm and are not suitable.
Cereal should be served with pieces no bigger than 1.5cm x 1.5cm, with their texture fully softened in milk. Drain any excess liquid before serving or thicken the milk if advised to have thickened fluids.
Rice requires a sauce to moisten it and hold it together.
No: hard, tough, chewy, stringy, dry, crispy or crunchy bits
No: Pips, seeds, skins or husks
No: Floppy foods, e.g. lettuce, spinach, cucumber
No: bread or toast due to high choking risk!
Not everything needs to be prepared from scratch - many different convenience foods can be used.
You can purchase ready-made Level 6 soft and bite-sized meals from suitable companies, e.g. Wiltshire Farm Foods https://
Maximum Nutrition to help maintain weight
If you have problems chewing or swallowing, or are unable to eat ordinary solid food for any other reason, it can be difficult to achieve a balanced diet. However, your body still needs just as much nourishment. It is important to maximise your nutrient intake, especially protein and energy.
How to make everyday foods more nutritious
Fortified Milk
Add 2-4 tablespoons of dried milk powder to a pint of full fat milk*. Keep in the fridge and use in drinks and cooking. Use milk or evaporated milk in place of water in soups, jellies, puddings and bed-time drinks.
Breakfast Cereals
- Use fortified milk– (recipe above)
- Sprinkle an extra spoonful of sugar* on top
- Add cream/ double cream*, evaporated milk, syrup or honey to porridge
Cereals need to be soaked in milk until soft with pieces no bigger than 1.5cm x 1.5xm. Any excess liquid should be drained, mixed consistencies should be avoided e.g. muesli
Soups
Add one or more of the following:
- Extra meat cut up into pieces no larger than 1.5cm x 1.5cm
- Cream or double cream* / Milk powder or fortified milk
- Lentils / Grated cheese
Mashed Potato
Add one or more of the following:
- Butter or spread* / Cream*
- Fortified milk / Grated cheese
Vegetables
Melt butter on top of vegetables, sprinkle with grated cheese or chopped hard-boiled egg, add milk or cream-based sauces*.
Puddings
Add one or more of the following:
- Cream or double cream* / Custard
- Evaporated milk / Condensed milk*
- Sugar / Honey / Syrup* / Jam*
Avoid ‘diet’ and ‘low fat‘ milk, yoghurts and desserts and choose ‘thick and creamy’ or ‘full fat’ instead.*
Nourishing Drinks
- Whenever you do not feel like eating, have a nourishing drink.
- High protein drinks can be bought from most chemists, e.g. Build-Up, Meritene or Complan and are available in a variety of flavours.
- Try adding your own ingredients such as Crusha Syrup, pureed fruit, drinking chocolate* to natural/vanilla flavoured drinks.
- Prepare home-made shakes using fortified milk and e.g. ice cream, cream*, banana or honey*.
- Drinking chocolate*, malted drinks and cocoa made with full-fat* or fortified milk.
- Have nourishing drinks between meals rather than at mealtime to prevent filling up on fluid.
If you need thickened fluids, make sure your drinks, sauces and soups are the correct consistency as advised by your Speech and language therapist. Avoid foods that turn to liquid in the mouth, e.g. ice cream, jelly.
If you are concerned about your food /fluid intake, are experiencing symptoms such as constipation/ weight loss or require more information on appropriate meal ideas or recipes, please speak to your dietitian.
Meal Suggestions
(All examples suggested below should be cut into pieces no bigger than 1.5cm x 1.5cm)
Breakfast
- Weetabix, porridge, ReadyBrek
- Scrambled, poached or boiled eggs, omelette
- Yoghurt
- Soft fresh or preserved fruit pieces such as bananas, ripe pears, stewed apples, tinned peaches (drain off excess liquid)
- Pancakes with butter* or maple syrup
- Baked beans
- Skinless sausages*, tinned tomatoes
Main Meals (add extra sauce/gravy)
- Vegetables steamed or boiled, cauliflower cheese
- Potato, sweet potato, yams, plantain, (no skin/crusts) – mash with milk and butter*
- Steamed/baked/poached fish
- Flaked fish (e.g. tuna) with extra sauce/mayonnaise
- Braised, stewed or roasted tender meat
- Minced meat (chicken, pork, lamb, beef)
- Fish or shepherd’s pie
- Corned beef hash
- Vegetable curry
- Lentil dhal
- Soft pasta with sauce, macaroni cheese, spaghetti bolognaise
- Eggs – scrambled, boiled, omelette (plain or cheese)
- Ripe avocado
- Crustless quiche
- Lasagne
- Dumplings soaked in dhal, e.g. channa or moong.
- Lentils are cooked until soft and mashed down with margarine*, ghee* or gravy
Desserts
- Crème caramel*
- Yoghurt, blancmange, mousse (full fat varieties*)
- Arctic roll*
- Custard
- Creamed rice or tapioca (made with fortified milk and cream*)
- Moist steamed puddings, sponge cakes
- Stewed, tinned or soft fresh fruit (no skins or hard dry fruit) with cream*/full- fat yoghurt *
- Jelly/ice-cream – these items are not suitable for those recommended to have thickened fluids because they melt into a thin liquid consistency in the mouth
Light Meals and Snacks
- Soups (thickened if necessary)
- Tinned spaghetti or spaghetti hoops
- Soft pasta filled with meat or vegetables (e.g. ravioli)
- Jacket potato (discard skins) mixed with cheese/tuna/baked beans/ cream and butter
- Omelettes
- Blended fruit drinks or supplements
- Smooth dips such as hummus or avocado
- Cottage Cheese
For instructions on how to make an appropriate alternative to sandwiches see: https://
*If you’ve had a stroke, heart attack or have diabetes, these foods may not be suitable as part of your everyday diet. Please contact a Dietitian for more advice.
High Risk Foods
|
Food characteristics to AVOID |
Examples of foods to AVOID |
|
Mixed thick and thin textures |
soup with pieces, cereal with milk |
|
Hard or dry food |
nuts, raw vegetables, dry cakes, bread, dry cereal, sausage rolls |
|
Tough or fibrous foods |
steak, pineapple |
|
Chewy |
sweets, cheese chunks, chewing gum |
|
Crispy |
crackling, crispy bacon, cornflakes |
|
Crunchy food |
raw carrot, raw apple, popcorn |
|
Sharp or spiky |
corn chips and crisps |
|
Crumbly bits |
dry cake, dry biscuits |
|
Pips, seeds |
pumpkin seeds, watermelon seeds |
|
Food with skins or outer shell |
peas, grapes, chicken skin, salmon skin, sausage skin, oranges, kidney beans |
|
Foods with husks |
corn, shredded wheat, bran |
|
Bone or gristle |
meat/fish bones, meat with gristle |
|
Sticky or gummy food |
nut butter, overcooked porridge |
|
Stringy food |
beans, rhubarb, lettuce |
|
Floppy foods |
lettuce, cucumber, raw spinach |
|
Crust formed during cooking or heating |
cheese topping, crusty mashed potato |
|
Juicy food |
where juice separates from the food piece in the mouth, for example watermelon, grapes |
|
Large or hard lumps of food |
Large pieces of non-tender meat |
Eating Out
If you are eating out, let the restaurant know in advance that you have special requirements - most places will be happy to help.
Good Feeding Practices
People who experience difficulty swallowing may require extra help when eating and drinking to ensure that food and drink go down the right way. Below is a list of helpful tips to encourage safe eating and drinking.
Alertness
- Eat and drink when most alert
- If eating and drinking is tiring try to eat smaller but more frequent meals, a ‘little and often approach’ with appropriate snacks between meals
Positioning
- Ensure sitting fully upright when eating and drinking (i.e. at 90o)
- Stay sitting upright for 30 minutes after eating and drinking
- Encourage sitting out in a chair for meals if possible, with hips well back and feet flat on the floor
- If eating and drinking in bed use pillows to support upright sitting if necessary
Oral Care
- Ensure mouth is kept clean and moist
- Ensure dentures are put in before eating
- When you have finished eating, clean mouth and dentures and remove any food residue remaining in the mouth
Environment
- Ensure you can concentrate on eating and drinking and are not distracted by the television, radio or conversation
- If feeding somebody, sit at the same level as them and make eye contact when feeding them
Food
- Explain what the food is and be positive about it
- Make meals look appetising
- Do not mix entire meal together, serve meat, vegetables and carbohydrates separately on the plate
- Make sure your mouth is clear of food and drink before taking the next mouthful. You may need to swallow more than once to clear each mouthful.
- Try to keep meals warm if they take a while to eat
Feeding
- Feed yourself where possible
- If self-feeding is not possible, try to support the person to feed themselves using hand over hand assistance
- Small mouthfuls of food/drink are safer than large mouthfuls
- Allow plenty of time to swallow
- If you become tired, take regular breaks
- If impulsive - try only offering small volumes of food and fluid at once
- Try to avoid using beaker lids and straws as they encourage fluids to travel more quickly through the mouth, potentially reducing control over them and resulting in higher risk of aspiration. Only use them if absolutely necessary
Patients with Other Health Conditions
If you have other health conditions such as diabetes, food allergies, high cholesterol, high blood pressure etc. the information within this leaflet may not be suitable. Please contact your Dietitian if you need any further information.
How can I test my food to make sure it meets Level 6 Soft and Bite-Sized requirements?
Finger Test
Use a sample the size of a thumb nail (1.5cm x 1.5cm). It is possible to squash a sample of this texture using finger pressure such that the thumb and index finger nails blanch to white. The sample will not return to its initial shape one pressure is released.
Fork Pressure Test
Pressure from a fork held on its side can be used to ‘cut’ or break this texture into smaller pieces.
When a sample the size of a thumb nail (1.5 x 1.5cm) is pressed with the base of a fork to a pressure where the thumb nail blanches to white, the sample squashes and changes shape, and does not return to its original shape when the fork is removed.
Reference
The International Dysphagia Diet Standardisation Initiative 2019 https://
Contact us
If you have any queries relating to this information, please contact the Speech and language therapy service.
About this information
Service:
Speech and language therapy
Reference:
VV/005
Approval date:
20 September 2024
Review date:
1 July 2027
Click ‘show accessibility tools’ at the bottom of the page
Then click ‘select language’
Alternative formats
You can use the accessibility toolbar at the bottom of your screen to:
-
Change the text size
-
Adjust the font
-
Modify the colour contrast
-
Use the translate function
If you would like this information in another format, such as Braille, audio, or easy read, please speak to a member of staff.
You can also print as well as download as PDF using the “Print this page” button at the end of the page.
Staff will print a copy for you on request
Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.