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Training

DYSPHAGIA DIETS

By: Lisa
Homiak

PURPOSE OF DIET
Allow safe eating for patients with:
Chewing problems
Swallowing problems

MEDICAL CONDITIONS
Achalasia esophageal muscle (sphincter) doesnt relax
properly to let food enter your stomach
Neurological - movement disorders (MS, Parkinsons)
Radiation therapy for cancer --> inflammation and scarring
Stroke (CVA) or spinal cord injury
Esophageal stricture (narrowing)
Scar tissue (often caused by GERD - reflux)
Aspiration: When solids or liquids that should be swallowed
into the stomach are instead breathed into the respiratory
system or lungs
May occur under effects of general anesthesia

DETERMINATION OF DIET
Speech Therapists will decide if its safe for a person to eat
Bedside swallow study:
Clear throat
cough
speak clearly
tongue range of motion and protrusion (strength to move tongue)
sip water from spoon without difficulty and swallow
sip from straw and swallow without difficulty
no oral obstructions such as dentures

If patient fails, a Barium Swallow may be ordered:

https://www.youtube.com/watch?
v=xDGg3djm1Es&list=PLSH7XmLtv0C5Y_zgpO48cE6TqQ8mPJ3eU
&index=5
https://www.youtube.com/watch?v=_dBPKBg8jXM

T YPES OF DYSPHAGIA DIETS

Level 1: Pureed
Blenderized, pudding like foods

Level 2: Mechanically Altered

Moist, soft-textured, ground

Level 3: Advanced
Nearly regular texture
No hard, sticky, or crunchy foods
Chopped

LIQUID CONSISTENCIES
FOR ALL 3 DYSPHAGIA DIETS:
LIQUID CONSISTENCIES MAY BE RESTRICTED:
THIN
NECTAR-THICK
HONEY-THICK
SPOON-THICK*

LEVEL 1: PUREED
MODERATE TO SEVERE DYSPHAGIA
REDUCED ABILIT Y TO PROTECT AIRWAY
IMPAIRED CHEWING AND SWALLOWING

LEVEL 1: PUREED
ALLOWED:
Pureed bread mixes
Any beverages without chunks or pulp (depending on liquids
consistency allowed)
Smooth, cooked cereals
Smooth puddings, custards, yogurts
PUREED: fruits, vegetables, soups, meats
Mashed or pureed potatoes

IF NO THIN LIQIUDS ON DIET - NOT ALLOWED:

ANYTHING THAT TURNS TO LIQUID AT ROOM TEMP
EXAMPLES?
JELLO
FRUIT ICE

LEVEL 2: MECHANICALLY ALTERED

GROUND
MILD TO MODERATE DYSPHAGIA
CHEWING ABILITY REQUIRED

TRANSITION FROM PUREED TO MORE SOLID TEXTURES

Foods are well cooked and moistened
Some mixed textures - assess for tolerance

LEVEL 2: MECHANICALLY ALTERED

GROUND
ALLOWED:
ALL DYSHPAGIA LEVEL 1 FOODS (RESERVED)
Any beverages (depending on liquids consistency allowed)
Soft pancakes, well moistened
Cooked or moistened cereal with minimal texture
Oatmeal, rice krispies

Soft drained canned or cooked fruits and vegetables

Pudding, custard, yogurt
SOUPS HAVE MEATS OR VEGETABLES < INCH
MEATS ARE GROUND OR MINCED TO INCH PIECES
MOIST WITH SOME COHESION

LEVEL 3: ADVANCED
MILD DYSPHAGIA
TRANSITION TO REGULAR DIET
ADEQUATE DENTITION AND MASTICATION REQUIRED
EXPECTED THAT MIXED TEXTURES ARE TOLERATED
Should still be assessed on individual basis
Foods should be moist and in bite-size pieces

LEVEL 3: ADVANCED
ALLOWED:
ALL DYSHPAGIA LEVEL 1&2 FOODS (reserved)
Any beverages (depending on liquids consistency allowed)
Any well-moistened breads, pancakes, biscuits, cereals
Canned and soft, peeled fresh fruits
Cooked, tender vegetables and lettuce
Thin-sliced, tender, or chopped meats
All potatoes and starches, including rice
Soups without tough meats
Strained corn or clam chowders

NO STRAWS
Some patients are at risk of aspiration, and are not allowed
to drink through a straw.
The act of using a straw requires reflexes that they may not possess

If their diet order says NO STRAWS, it is VERY IMPORTANT to

ensure they do not receive a straw on their tray.
Consequences include:
Aspiration
Choking

CASE STUDIES
Mr. X was put on a Level 1 Dysphagia Diet with nectar thick
liquids. He orders pureed butternut squash soup for lunch. You
notice the soup appears too thin. Can you send it?
Mrs. Y has a diet order of Dysphagia Level 3 no thin liquids.
For lunch she orders cream of chicken rice soup, a lettuce
salad with ranch dressing, and fruit ice. What is wrong with
her order?
Mr. Z is on a Level 2 Dysphagia Diet. He orders pancakes for
breakfast but states he does not want them moistened with
syrup. What other options could you offer him instead?

THE END
QUESTIONS?