Making Minced Meat Out of the Minced and Moist Diet

With the new guidelines from the International Dysphagia Diet Standardization Initiative (IDDSI), we now have very clear definitions for diet consistency and texture, and guidance on how to test the foods to be sure they are correct. This is vital, since choking is a leading cause of death for individuals with intellectual and developmental disabilities.

A mechanically altered diet is now known as a Level 5 Minced and Moist Diet. You can see how it fits within the framework below. While many aspects of the Minced and Moist diet are the same as the mechanically altered, there are some important differences, and there is more structure to help you identify the correct consistency.

Identifying and Testing Level 5 Minced and Moist Foods

Minced and moist foods should be soft and moist, but should have no liquid dripping from it. It should require minimal chewing and no biting. The size of the food particles should be no more than 4 millimeters wide. This is about the size that would fit between the tines of a fork. See the two images below to compare acceptable and unacceptable testing of particle size.

You should be able to scoop the food onto a fork or spoon without crumbles falling off, and with no liquid dripping from it. Any lumps should be able to be mashed with the tongue. Lastly, these foods should not be sticky, as this may cause food to stick in the throat, mouth, gums, and teeth.

Moist and minced foods may be tested for proper consistency using the fork drip and spoon tilt tests. The food must pass both tests. Note that these are the same tests used for Level 4 Pureed foods.

Fork Drip Test – Scoop the food onto a fork. The food should sit in a mound on the fork without any liquid dripping through the prongs. A small amount is permitted to flow through the prongs and form a “tail” below, but should not drip.

Spoon Tilt Test – Scoop a sample of the food onto a spoon. The sample should sit in a mound on the spoon. Tilt the spoon to the side. The sample should slide off the spoon, leaving little or no residue on the spoon. The sample should not be firm or sticky.

How To Get the Right Texture and Consistency

To prepare foods to level 5 minced and moist, you will need a food processor. If you or the individual has a meat grinder, that may work for some of the foods, too. You may be able to chop the food fine enough by hand, but this is not recommended to avoid inconsistency. Add the food to the food processor. It’s helpful to cut the food into smaller pieces before putting it in the machine. It’s also best to prepare more than one serving of food at a time, because most machines have trouble with small amounts – plus you’ll make less work for yourself in the future.

Turn the dial to “mince” or “medium-high.” Turn the machine off, and scrape down the sides as needed. Continue doing this until the food is very small, but not pureed. Test the particle size using the fork prong test above. Use one of the liquids below to moisten the food so it will hold together. Remember the liquid should not separate from the food. A thick, non-pourable sauce is recommended for this reason, though there may be some times when you would use a thinner liquid.

Liquids that may be used to moisten minced foods (not all of these are appropriate for every situation):

• Gravy
• Marinara or Alfredo sauce (with no lumps or pieces)
• Cheese sauce
• Any other thick, lump-free sauce the individual likes
• Chicken/beef/vegetable broth
• Milk or cream
• Non-Dairy Milk (soy, almond, etc.)
• 100% Vegetable juice
• 100% Fruit juice

*Note: Except for bread in sandwiches (see video below) do not use water to moisten minced foods. Water dilutes the flavor of foods, making them less tasty.

Generally, you will drain away any excess liquid. In the event all or most of the moistening liquid seems to be running out of the food, thickeners may be used. In that case, start with only a small amount of thickener, and add more as needed. Use one of these thickening agents if the liquid is separating from the food (not all of these are appropriate for every situation):

• Thick-It, Thicken Up, etc.
• Powdered Milk
• Powdered Mashed Potatoes
• Canned pumpkin or sweet potatoes
• Applesauce
• Hummus or other pureed beans

What to Serve on a Level 5 Minced and Moist Diet

Here are some examples of foods in appropriate textures that can be served on a Level 5 diet:

• Meat and fish that is finely chopped or minced to a 4 mm diameter with a thick sauce or gravy
• Fruit that is finely mashed, or chopped to a 4 mm lump size, with any excess liquid drained away
• Vegetables that are cooked until very soft, and mashed or chopped into 4 mm size pieces, with any excess liquid drained away
• Cereal that is thick with small, soft, 4 mm or less lumps. Any milk should not separate, and excess liquid drained away.
• Rice with a thick sauce, to moisten and hold it together. Rice should not be sticky or gluey, and rice grains should no separate when cooked and served.
• Sandwiches made according to the guidelines – bread and all filling chopped to 4 mm pieces and moistened. See this demonstration video from IDDSI for instructions to make a sandwich for Level 5.

Foods to Avoid on the Level 5 Minced and Moist Diet

While many foods can be ground and minced to the proper size and texture, there are some that generally can’t achieve the correct texture. These are some foods that should not be given to someone on a level 5 minced and moist diet (please note that this list may not be exhaustive, and caretakers will need to use professional judgement):

• Peanut butter and other nut butters
• Foods with mixed textures, like soup with chunks of food in it, or cereal and milk
• Chewy foods like marshmallows, chewy candy, chewing gum, and cheese chunks
• Dried fruit
• Regular bread (see above instructions for making bread meet the guidelines)
• Crispy food like bacon or corn flakes
• Crunchy foods like raw vegetables and popcorn
• Hard raw fruit, like apples, fruits with skin, like grapes, or fibrous fruits, like pineapple and rhubarb
• Nuts and seeds
• Chips, pretzels
• Dry foods like cake and biscuits
• Corn and peas
• “Skins” like on sausage, or skins of chicken, salmon, etc.
• Meat with bones or gristle in it (chicken leg, some steak, etc.)
• Any crust or skin that forms on food after heating, like on cheese
• Over cooked oatmeal or porridge
• “Floppy” foods, like lettuce, cucumbers, and uncooked spinach
• Juicy foods where liquid separates from the food in the mouth, like watermelon
• Any food bigger than 4 mm in diameter

Tips For Feeding

Since individuals requiring a level 5 minced and moist diet are at an increased risk of choking, there are some tips and strategies you can use to help lower that risk. Unless otherwise ordered by a physician or speech therapist, follow these tips:

• Have the person sit upright at all times, and wear/use any adaptive equipment needed, including during administration of medication, and while drinking beverages.
• If the individual is able to eat unassisted, do not feed them. If assistance is needed, provide the minimal assistance necessary. This helps preserve the individual’s dignity.
• Use a small spoon, or a “baby” spoon. Having too much food in the mouth at a time is a choking hazard.
• Allow the person adequate time to chew the food and swallow before offering more. Do not rush.
• Offer a sip of a drink after each bite to help clear the mouth.
• Check the person’s mouth after each bite to make sure s/he is not holding food in the cheeks, and that it is not sticking to the teeth or the roof of the mouth.
• Do not comment negatively on the look, smell, or texture of the food. This can influence the person to not eat or eat less. Find something to comment positively on.
• Make efforts to make the foods look nice on the plate. Everyone eats with their eyes first. Use different shapes, sizes, and colors. Example:

Remember that some individuals on the Level 5 Minced and Moist Diet will also require thickened liquids. Always follow the individual’s diet and liquid order. Consult your supervisor, the speech therapist, or dietitian with any questions you might have about how to prepare certain foods or if it may or may not be given.

With the right strategies, you can prevent a majority of choking episodes!