Level 4 (Pureed) Diet

Level 4 (Pureed) Diet

Patient and Carer Information

Speech & Language Therapy

Why is a Level 4 (pureed) diet needed?

A level 4 diet may be recommended for the following reasons:

• You may not be able to bite or chew or you may have reduced tongue control.
• You may have weakness of the muscles that control your swallowing meaning that you are at risk of choking.

You may be suffering from fatigue that means you get tired before you have managed to eat enough.

Who decided I needed a Level 4 (pureed) diet?

This was decided by your Speech & Language Therapist, who will have assessed how well you are able to chew and swallow.

How long do I need to have this type of diet?

You may be reviewed by a Speech & Language Therapist in community, who will see if you can change the texture of your food, or this may be the safest option for you in the long term.

If you have not been referred to the Community Speech & Language Therapy Team by the hospital, you can request a referral via your GP.

What is a level 4 (pureed) diet?

• Thick and smooth consistency
• Usually eaten with a spoon
• Does not require chewing
• Has a smooth texture with no lumps
• Holds its shape on a spoon
• Falls off a spoon in a single spoonful when tilted
• Are not sticky
• Liquids (like sauces) are not separate from solids

How do I make level 4 (pureed) diet?

The best way to prepare level 4 foods is using a liquidiser or blender.  You will need to adjust the amount of fluid you add to obtain the correct consistency. Do not add water, as it decreases the nutritional value of the food; try adding liquids such as gravy or milk instead. Some foods will require sieving to remove lumps, particles or stringy bits.

You should not liquidise foods that are ‘flaky’ or that have skins or pips (e.g. very tough meat, pastry, salad, bread/sandwiches, and hard fruits)

How do I know it’s the right consistency?

Level 4 foods will sit on a mound or pile on a fork. It should not dollop or drip continuously through the fork prongs.

Level 4 foods will hold their shape on a spoon and fall off fairly easily if the spoon is tilted.

Level 4 foods should not be firm or sticky as this can cause them to stick to the cheeks, teeth, roof of the mouth or throat.

Foods to avoid

• Mixed thick and thin textures: e.g. soup with pieces of meat or vegetables, cereal with milk
• Hard or dry food: e.g. nuts, raw vegetables, dry cakes, bread, dry cereal
• Tough or fibrous foods: e.g. steak, pineapple
• Chewy foods: e.g. lollies/toffees/sweets. Cheese chunks, marshmallows, chewing gum, sticky mashed potato, dried fruits, sticky foods
• Crispy textures: e.g. crackling, crisp bacon, cornflakes
• Crunchy foods: e.g. raw carrot, raw apple, popcorn
• Sharp or spiky foods: e.g. crisps
• Food with crumbly bits: e.g. dry cake, crumble, dry biscuits
• Pips or seeds: e.g. apple seeds, pumpkin seeds, white of an orange
• Foods with skins or outer shells: e.g. peas, grapes, chicken skin, salmon skin, sausage skin
• Foods with husks: e.g. corn, shredded wheat, bran
• Bone or gristle: e.g. chicken bones, fish bones, meat with gristle
• Round, long shaped foods: e.g. sausages, grapes
• Sticky or gummy foods: e.g. peanut butter, overcooked porridge, jelly, sticky rice
• Stringy foods: e.g. beans, rhubarb
• Floppy foods: e.g. lettuce, cucumber
• Foods where a crust forms during cooking or heating: e.g. on mashed potato, custard or a cheese topping
• Juicy foods: e.g. where juice separates from the food piece in the mouth, for example watermelon
• Foods with visible lumps e.g. lumps in pureed foods, yogurt with lumps of fruit

Where can I find more information about level 4 foods?

Please ask your Speech & Language Therapist for more information, or you can visit the following website: www.IDDSI.org

Reference

“Complete IDDSI Framework Detailed Definitions”, International Dysphagia Diet Standardisation Initiative, 2017 www.iddsi.org