How To Follow a Level 6 Soft and Bite-Sized Diet

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This information explains what a level 6 soft and bite-sized diet is and how to follow it. It explains how to test your food’s size and thickness. It also lists foods to include and avoid while following this diet.

What is a level 6 soft and bite-sized diet?

A level 6 soft and bite-sized diet is when you only eat foods that are:

  • Soft.
  • Tender.
  • Moist.
  • Easy to chew and swallow.
  • Easy to cut with a fork. You do not need a knife.

Bite-sized foods should be 1.5 centimeters (cm) by 1.5 cm (about .5 by .5 inches) or smaller. This is about the size of your thumbnail.

Some foods may be hard to serve at this size. If you cannot make your food soft and bite-sized, you can mince and moisten it instead. Mincing your food means grinding, cutting, or chopping it into very small pieces. To learn more, read How To Follow a Level 5 Minced and Moist Diet.

Why do I need to follow a level 6 soft and bite-sized diet?

You may have to follow a level 6 soft and bite-sized diet if you:

  • Have dysphagia (dis-FAY-jee-uh). Dysphagia is when you have trouble swallowing.
  • Cannot bite off pieces of food safely but can chew food into pieces to swallow.
  • Have pain when chewing food.
  • Have trouble chewing food.
  • Have missing teeth.
  • Have dentures that do not fit well.

How can I make sure my food is soft enough?

You can check your food’s softness by doing a fork pressure test. Follow the steps in this section.

Your food’s texture can change based on its temperature and how you cooked it. Test your food right before you start eating it to make sure it’s the right softness.

Fork or spoon pressure test

Place your fork or spoon over your food. Using your thumb, press down on your fork or spoon until your nail turns white. Your food is soft enough if it is completely squashed and does not go back to its original shape. Your food should also easily break apart with the side of a fork or spoon.

Figure 1. Fork or spoon pressure test

What can I eat on a level 6 soft and bite-sized diet?

Here are some foods you can eat while following this diet. We also list some foods you should avoid.

These tables are not a complete list of foods you can eat on this diet. Other foods may be OK to eat if you test them and they are the right size and texture.

 Try to eat moist foods while on this diet. To keep foods moist, add small amounts of:

  • Water
  • Broth
  • Gravies
  • Sauces
  • Juice
  • Milk or half and half
  • Yogurt

If you have trouble swallowing liquids, your speech language pathologist may recommend you thicken your liquids. If you need to thicken liquids, read About Thickening Liquids.

Milk and dairy

Milk and dairy to includeMilk and dairy to avoid
  • Yogurt.
  • Cottage cheese and ricotta cheese.
  • Cream cheese and sour cream.
  • Cheese chunks that are 1.5 cm by 1.5 cm (about .5 by .5 inches) or smaller.
  • Ice cream, frozen yogurt, gelato, milkshakes, and smoothies.
  • Yogurt with nuts or coconut.
  • Hard or dry cheeses larger than 1.5 cm by 1.5 cm (about .5 by .5 inches).

Proteins

Proteins to includeProteins to avoid
  • Red meat, such as beef, pork, and sausage, without skin or casing.
  • Poultry, such as chicken and turkey, without skin or bones.
  • Seafood, such as fish, shrimp, lobster, clams, and scallops.
  • Eggs and egg substitutes (including quiche).
  • Soy foods, such as tofu and tempeh.
  • Moistened legumes, such as cooked beans and lentils.
  • Prepared, moistened meat alternatives, such as plant-protein veggie burgers and plant-based sausages.
  • Casseroles with soft chunks of meat, ground meat, or tender meats, chopped and served in any sauce.
  • Chicken, egg, or tuna salad without raw vegetables.
  • Smooth nut butters.
  • Meats larger than size requirements.
  • Chicken, turkey, or fish with skin or bones.
  • Sausage with skin or casing.
  • Whole nuts and seeds.

Vegetables

Vegetables to includeVegetables to avoid
  • Soft, cooked vegetables served steamed or boiled.
  • Peas, creamed peas, and creamed corn with soft skins. You can blend these or add them to stews and soups.
  • All raw vegetables, including lettuce.
  • Stir-fried or fried vegetables.
  • Cooked vegetables that are fibrous, tough, or firm, such as stir-fried vegetables and eggplant skin.

Fruits

Fruits to includeFruits to avoid
  • Canned and cooked fruits.
  • Soft, peeled fresh fruits, such as peaches, kiwi, nectarines, cantaloupe, and honeydew.
  • Soft berries with small seeds, such as strawberries.
  • Avocado, including guacamole.
  • Fresh fruits with chewy skin or seeds, such as grapes, apples, and pears.
  • Stringy, high-pulp fruits and fibrous fruits, such as rhubarb and fresh pineapple.
  • Fresh fruits with high water content where the juice separates from the solid once chewed, such as watermelon.
  • Dried fruits, freeze-dried fruits, and fruit snacks.

Starches

Starches to includeStarches to avoid
  • All well-moistened soft, cooked cereals.
  • Well-moistened cold cereals.
  • Pasta and potato dishes.
  • Baked potato without skin.
  • Couscous, quinoa, or rice served in smooth, thick sauce.
  • Croissants, plain sandwich bread, and muffins.
  • Hot, open-face sandwiches with or without sauce or gravy.
  • Cold sandwiches.
  • Sandwich bread with nuts and seeds.
  • Dry crackers, chips, popcorn, and taco shells.
  • Baked potato with skin.

Fats

Fats to includeFats to avoid
  • Butter, margarine, oils, mayonnaise, sour cream, gravies, and salad dressings.
  • Whole nuts and seeds.
  • Coconut.

Soups

Soups to includeSoups to avoid
  • Pureed soups or soups with small soft pieces that are 1.5 cm by 1.5 cm or smaller.
  • Soups with food pieces larger than 1.5 cm by 1.5 cm.

Sweets and desserts

Sweets and desserts to includeSweets and desserts to avoid
  • Pudding, custard, and whipped toppings.
  • Ice cream, sherbet, and sorbet.
  • Crustless New York-style cheesecake.
  • Gelatin (such as Jell-O®), flavored fruit ices, and popsicles.
  • Cakes, pies with soft crusts, and pastries without nuts or dried fruits.
  • Cakes with wet or dried nuts.
  • Chewy caramel and taffy-type candies.

Other

Other things to includeOther things to avoid
  • Salt, pepper, ketchup, mustard, herbs, and spices.
  • Seedless jellies, jams, and preserves.
  • Honey, sugar, and sugar substitutes.
  • All syrups, including chocolate syrup and maple syrup.
  • Jellies, jams, and preserves with seeds.

Sample menu for a level 6 soft and bite-sized diet

Use this sample menu to get ideas for making your own level 6 soft and bite-sized diet meals.

Level 6 soft and bite-sized diet menu
Breakfast
  • Oatmeal
  • Diced scrambled eggs
  • Mandarin oranges, cut into pieces
  • A glass of milk
Mid-morning snack
  • Vanilla yogurt
  • A glass of grape juice
Lunch
  • Moist diced beef stew with diced potatoes and carrots
  • Diced fruit
  • A glass of apple juice
Mid-afternoon snack
  • Rice pudding
Dinner
  • Moist diced chicken with gravy and orzo pasta
  • Cooked cut carrots
  • Canned, cut peaches
  • A glass of coconut water
Evening snack
  • Sherbert with diced strawberries

Tips for adding more calories to your diet

  • Add 2 to 4 tablespoons of canned coconut milk or cream to smoothies, shakes, cereals, and yogurts for extra calories. You can also add it to dishes for extra calories, flavor, and moisture.
  • Choose creamy soups rather than soups with clear broths.
  • Have puddings and custards rather than gelatin desserts, such as Jell-O.
  • Add sauces, gravies, butter, or extra vegetable oil to your meals.
  • Drink fruit shakes or fruit smoothies made with yogurt or ice cream.
  • Make ice cubes from milk or fruit nectar. Use these high-calorie ice cubes in smoothies or to keep your shakes cold. As they melt, they will add calories to your drinks.
  • Drink high-calorie drinks, such as whole milk, milkshakes, or pasteurized eggnog.
  • Use oral nutrition supplements, such as Ensure® or Boost®, as a nutritious, high-calorie liquid base in smoothies and milkshakes.
  • Add honey to smoothies, tea, yogurt, hot cereals, shakes, or ice cream.
  • Add sour cream, half and half, heavy cream, or whole milk to your foods. You can add them to mashed potatoes, sauces, gravies, cereals, soups, and casseroles.
  • Add avocado to dishes or smoothies and blend.
  • Blend nut butters, such as peanut butter, into shakes and smoothies.

Tips for adding more protein to your diet

  • Add pureed tofu to cooked vegetables, soups, or smoothies. You can also eat tofu instead of chicken or meat if you’re having trouble eating animal proteins.
  • Add pureed cooked eggs to your soups, broths, and cooked vegetables.
  • Use plain full-fat Greek yogurt in smoothies, cream sauces, or wherever you would use sour cream.
  • Use a plain protein powder, such as whey or pea protein powder, in liquids and shakes.
  • Add full-fat ricotta cheese to moisten a dish and add calories and protein.
  • Add cottage cheese to smoothies or pureed fruit.

Contact information

If you have questions or want to make an appointment with a clinical dietitian nutritionist, call 212-639-7312.

Last Updated

Thursday, April 25, 2024

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