Mixing it up

Can people with dysphagia have ‘mixed textures’ on the plate?

No.

But now and again, Yes.

Have you noticed how every time we pose one of these questions, the answer is rarely straightforward?

This is because we’re supporting individuals. People with specific needs, wishes and preferences on a background of comorbidities and treatments unique to them.

There is no ‘one size fits all’ approach in dysphagia management and IDDSI certainly isn’t one size fits all either.

If you care for someone with dysphagia, you need to know exactly what the speech and language therapist’s swallow recommendations are. These may be provided on an advice sheet or leaflet, or in a report, or in a care setting, you’ll find what you need in the dysphagia care plan.

Never make changes to dysphagia management without checking with the speech and language therapist or a medic first. If you do, and something goes terribly wrong, you’re liable.

This is also true of catering colleagues. Don’t always assume that Level 4 purée diet foods on a plate when someone can tolerate a Level 5 minced and moist diet or even greater textures is ok for an individual. There could be specific reasons why mixed textures don’t help or could be risky.

Important considerations with mixed textures;

  • one of the textures may move more quickly through the mouth and into the throat whilst the person is still trying to work on the food that is left; this makes it harder to control and some of it could hit the airway – at IDDSI Levels 4, 5 and 6, the consistency on the plate should be uniform unless otherwise advised in the care plan
  • ill-prepared IDDSI Level diets, where there are multiple textures on the plate will pose a risk of choking, chest infections or aspiration pneumonia and could also lead to malnutrition if it doesn’t look appetising
  • residue may be left behind in the mouth or throat, which could pose a choking or chest infection risk later, or an aspiration pneumonia risk as this also affects oral and upper airway hygiene
  • do not assume that taking sips of drinks to help food go down or clear the mouth is a good thing – some people benefit, but for others it increases the risk of airway compromise
  • de-skilling of the person with dysphagia; we get used to what we get used to. The whole point of rehab is that it’s challenging otherwise there’s no change, so providing Level 4 purée diet foods too often, when they’re recommended Level 5 or higher as part of a rehab regime isn’t always helpful – if the person is at risk of malnutrition and may take more at a lower IDDSI level, the speech and language therapist needs to be advised / ask the questions and make recommendations / referrals accordingly

In short, the question isn’t Can people with dysphagia have ‘mixed textures’ on the plate? but What does the care plan say and am I following it?

If you have any questions or concerns when supporting someone with dysphagia, do check with the speech and language therapist.

Published by Sandra Robinson

Independent Speech and Language Therapist. Specialist Dysphagia Practitioner.

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