This information sheet is for people undergoing radiotherapy to the head or neck. It aims to explain which foods may cause difficulty and how to manage this.
The International Dysphagia Diet Standardisation Initiative (IDDSI) aims to provide common terminology for describing food textures to improve safety for individuals who experience swallowing difficulties.
Effects of radiotherapy on swallowing
The side effects of radiotherapy build up as treatment progresses and can affect your swallowing, so you may need to adapt what you eat or drink as you go through treatment.
Gradually modifying the texture of your food and adding extra moisture can make foods easier to swallow. Similarly, after the radiotherapy side effects have started to settle, gradually re-introducing lumpier and more solid consistencies is important to help you return to a normal diet as possible.
Your speech and language therapist will advise you on which IDDSI Level is safest in terms of your oral intake. Your dietitian will advise on maintaining adequate nutrition.
If you notice any of the following when eating or drinking, then please inform your speech and language therapist or doctor:
- coughing when swallowing (the feeling of something going down the wrong way)
- choking
- wet voice quality
- increased breathing rate
- watery eyes
Non-urgent advice: Hierarchy of food textures
The chart below depicts food textures on a five level scale, ranging from Level 3- Liquidised to Level 7- Regular Diet. Examples of foods are provided for each level. This is intended as a general guideline only, as everyone can be affected by the treatment in a different way.
7- Regular
- Normal, everyday foods of various textures.
- Meat, salad, chips, bacon, crackers, crisps, biscuits.
7 - Regularto chew
- Normal, everyday foods of soft/ tender textures that are developmentally and age-appropriate.
- Meat, fish and vegetables cooked until tender, scrambled eggs, well-cooked pasta and sauce, banana.
- Avoid crunchy and crumbly foods.
6 - Soft and bite-sized
- Can be mashed/ broken down with pressure from fork/ spoon and into 1.5cm pieces – needs chewing but no biting.
- Chopped banana, cottage pie, fish pie, soft pasta and sauce with soft cheese, plain soft omelette.
5 - Minced and moist
- Soft and moist with no separate thin liquid.
- Small lumps (easy to squash with tongue) visible within the food.
- Very thick porridge with small soft lumps, egg mashed with sauce added, mashed banana, mashed fish in thick sauce, rice pudding, stewed fruit with thick yoghurt, mashed potato, well-cooked broccoli/ cauliflower mashed.
4 - Puréed (purée meat, vegetables etc separately)
- Does not require chewing – everything to be puréed.
- Smooth porridge, milkshakes with puréed fruit (may require thickener), smooth yoghurt, Greek yoghurt with puréed banana and honey.
- Puréed chicken and gravy with vegetables, puréed fish in creamy sauce, thick smooth soup (thickener may be required).
3- Liquidised (all food must be liquidised)
- Liquidise foods using blender/ food processor – always add extra liquids such as gravy/ milk/ stock (try to avoid water as this reduces the goodness in the food).
- beef, lamb, chicken or fish: liquidise with gravy or sauce
- eggs: scramble and liquidise with milk or cheese sauce
- fruit: stew, then liquidise
- soft pasta: add extra sauce, then liquidise
Remember to thicken all fluids if you’ve been advised to do so. This can be achieved by adding thickener after foods have been liquidised or puréed.
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Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
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