Care Guides for Caregivers
Learning to Eat Normally Again (Oral Feeding)
Post on 03/07/16
If a patient requires to be fed by a tube, it is usually temporary. The patient will usually progress to oral feeds. Initially, the patient will be able to take only small amount of food and fluid.
The food may have to be blended. The amount, consistency and variety will gradually be increased over a few days. Tube feeding may still be continued to supplement the oral diet and fluids until sufficient amount can be taken orally. The following may help to improve the patient’s food and drink intake:
- During meals, the patient should be seated in a reclining or an upright position depending on his tolerance; provide head support if necessary
- The atmosphere should be relaxed with little distraction; provide cues to improve his attention. Encourage self-feeding to improve his level of independence
- If one side of his face is weaker, encourage him to place a small amount of food on the stronger side for chewing. Provide cues or help with lip closure if needed
- Make sure that he chews the food properly before swallowing it. Check for trapped food in the mouth, and clear it after every meal
- Some foods are safer and easier to eat than others. Pureed (blended) foods and very soft or minced foods are easier to swallow than big pieces of meat, vegetables and fruits
- Some patients cough while swallowing liquids or swallow very slowly. They need extra caution and supervision. Their swallowing might improve if the liquids are thickened with a commercial thickening agent, which is available in the pharmacies, or with common home foods
- Feed the liquids with a spoon or encourage him to sip in small amounts. Sipping through a straw is risky since the patient may not be able to control the amount he sips; the excess liquids may cause choking
- Encourage self-feeding with suitable utensils, seat the patient at the table so that he is able to see and help himself easily
- Encourage him to maintain the normal pace of eating and monitor the size of each mouthful taken to reduce the risk of choking and coughing
Eating blended foods with pleasure
- Make sure that all the recommended foods for healthy eating are included. Many everyday foods and food preparations can be made softer by mashing, mincing or blending
- Some examples of foods suitable for including in the diet are: pureed porridge, thick pureed soups, thick custards, baby cereals, baby foods, pureed soft fruits, pureed vegetables, soft bean curd, etc…
- A blender or a sieve will help to get a smooth and even-textured consistency if this is what is needed
- Make meals look and taste interesting
- Offer smaller meals if the patient is unable to take enough of the feed at one meal; increase the frequency of the meals
- Do not offer foods which he does not like
- Use fresh food as far as possible. Use the water that the food is cooked in, to blend food. Do not overcook the food
- If the amount of food taken in is not enough, include an appropriate nutritional supplement in the daily diet
- At least four to six glasses of fluid should be taken daily
- Provide enough fibre rich foods or a fibre supplement to prevent constipation
The purpose of a food thickener is to change the consistency of the food or liquid to make it thicker and easier to swallow. This will increase the range of foods the patient can have. Thickeners have extra calories. Some thickeners may change the taste of the food.
Foods that may be used as thickeners:
- Commercial: ‘Thick and Easy’, ‘Nestargel’, ‘Thicken-up’
- Common home foods to thicken liquids include: dried infant cereals, pureed fruit, soft puddings, pureed vegetables, yogurt, mashed potatoes.
- Common home foods to thicken solids include: dried infant cereals, rice powder.
Healthy diet principles
The generally recommended diet is one that is based on healthy diet principles. This means it should be sufficient in energy to keep a healthy weight, low in fat and cholesterol, low in sodium and high in fibre.
A healthy balanced diet can be achieved by eating a variety of different foods from different food groups according to the healthy diet pyramid, and not eating too much of any one food especially foods at the top of the pyramid.
Specific modifications may be needed under certain conditions.
Helpful hints to “shape up” the diet
- Cut down unwanted fats
- Use lean meat, poultry without skin and fish in recommended amounts
- Limit shellfish, prawns, crabs and organ meats (liver, kidney, tripe) to no more than once or twice a fortnight and to small portions
- Limit whole eggs to one to three a week •
- Use only polyunsaturated or monounsaturated oils and margarine for cooking and in small amounts •
- Use low fat or skimmed milk and milk products instead of full cream products
- Avoid butter, lard, dripping, coconut, non-dairy creamer, malted milk drinks and fatty processed meats
- Avoid or limit deep-fried foods
- Cut down salt (sodium)
- Avoid foods high in salt such as salted eggs and fish, salted vegetables, soya sauce, packet crisps and snacks, processed meats (barbecued meats, sausages), pickles, cheeses, soup cubes, other bottled sauces
- When eating out, ask for low salt and ‘no MSG’ •
- Gradually cut down the amount of salt used in cooking and add spices to compensate for flavour
- Reach for high fibre foods
Include high fibre varieties of the foods in the diet pyramid as a major part of the diet. For example:
- Whole grain rice, rice powder, noodles, breads and cereals
- Fresh fruit with skin if possible
- Vegetables especially as raw salads
- Dried beans and legumes
Aim for the healthy weight range
If weight is ideal, it is important to maintain it by following the above diet principles.
If underweight, then take extra amounts of the recommended foods and maintain the best possible activity level.
If overweight, then take slightly smaller portions of foods in the pyramid.
Some other helpful hints to reduce weight
- Avoid high calorie foods containing fat, sugar and alcohol
- Correct poor eating habits – do not skip meals; do not overeat at any one time
- To avoid temptation, do not place too many fatty snacks within reach
- Try to exercise at least three times a week, about 15 to 30 minutes each time
- If mobility is limited, you will need to increase activity level; ask your therapist to recommend appropriate exercises
Considerations for diabetes, high cholesterol,
high blood pressure, overweight
If the patient has diabetes, high blood cholesterol, high blood pressure or is overweight, following the above recommendations will help in improving the control of these conditions.
In diabetes, the type and distribution of carbohydrates is also important.
Further specific instructions, are provided by the dietitian upon discharge from hospital, if the patient has any of the above conditions.
Paying attention to nutrition is an investment in health. Relying on medical therapy alone is not enough. Along with nursing care and meeting the patient’s other needs, healthy and adequate nutrition will greatly enhance the quality of life.
- Following a stroke, the patient may not be able to swallow food. Tube feeding may therefore be necessary with the food being delivered in a liquid form through the tube
- The liquid feed selected for the patient is nutritionally complete formulae, convenient, hygienic and easily tolerated
- Feeding by tube is usually temporary. The patient will usually progress to oral feeds
- The amount, consistency and variety will be gradually increased over a few days. Tube feeding may still be continued to supplement the oral diet and fluids until sufficient amount can be taken orally
- Pureed (blended) foods and very soft or minced foods are easier to swallow than big pieces of meat, vegetables and fruits
- Some patients cough while swallowing liquids or swallow very slowly. Their swallowing might improve if the liquids are thickened with a thickening agent
- The generally recommended diet is one that is based on healthy diet principles. This means it should be sufficient in energy to keep a healthy weight, low in fat and cholesterol, low in sodium and high in fibre
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