Food Texture Modifications

Reviewed by: HU Medical Review Board | Last reviewed: August 2021

People with spinal muscular atrophy (SMA) may have difficulty swallowing and other feeding problems. This can lead to undernutrition, which can make muscle weakness worse. It can also lead to inhaling material into the lungs (aspiration). This can make lung and breathing problems worse.

People with SMA will often see a speech therapist. A “swallow study” may be performed. This can determine the types of foods and liquids that can be swallowed safely. A nutrition expert (a nutritionist or dietitian) can then use this information to create a diet of safe foods that provide enough nutrients.

Most people with type 1 or 2 SMA will need changes to their diet to favor softer foods and thicker liquids. People with type 3 SMA usually do not need food texture changes. Talk to your doctor about what level of food and liquid thickness is best for you. Ask them for examples of foods and liquids that fit this texture.

Why are texture modifications helpful for people with SMA?

People with SMA often do not get enough nutrients because of difficulty feeding. Muscle weakness makes it harder to chew and swallow. It also leads to poor tongue and head control, fatigue when chewing, and reduced mouth opening.1,2

Acid reflux is also a common problem for people with severe types of SMA. This happens when stomach contents move back up the throat. Acid reflux and difficulty swallowing increase the risk of inhaling food or liquid into the lungs (aspiration). This can cause breathing difficulty and lead to lung infections.3

One way to get enough nutrients safely is to choose easier foods to swallow. This usually includes:4

  • Changing food texture to improve feeding by mouth
  • Using a semi-solid diet to make it easier to chew
  • Using thickened liquids that are not as easily aspirated
  • Using specific tools like cups, straws, and spoons
  • Alternating solids and liquids
  • Taking smaller bites

What are some examples of texture modifications?

Soft food diets can help people get enough nutrients if they have difficulty swallowing. Each person with SMA has a different level of feeding ability and different nutrition needs. There is not 1 diet of soft foods that will work for everyone. For example, thick liquids are usually safer because they cannot be aspirated as easily. But thick liquids can cause hydration and other issues. It is best to drink the thinnest liquid that is tolerated.2,4

A nutritionist on your care team can suggest ways to modify foods and drinks on a personal basis. Some foods may be hard to chew or get easily stuck in the airway. Foods to avoid include:4

  • Dry meat and bread
  • Fruit with high pulp
  • Raw vegetables
  • Nuts and seeds
  • Peanut butter and other nut butters

Instead, your doctor can suggest foods that are naturally soft or that can be cooked to soften. Some examples of these foods include:4

  • Fruits and vegetables – Canned and cooked fruit, ripe bananas, soft peeled fresh fruits, soft berries, cooked vegetables, shredded lettuce
  • Meats and proteins – Moist ground meats, solid tender cuts, meatloaf, deli thin meat, chicken or egg salad, shredded cheese, eggs
  • Soup – Cream-based or broth-based soups, chili with soft beans
  • Grains – Hot cereals, moistened breads, pasta, moist rice
  • Desserts – Custard, moist cakes, pudding, yogurt
  • Dairy – Milk, milkshakes, soft cheese, yogurt with soft fruit

These foods need to be lightly chewed or broken up with the tongue. People with more serious chewing and swallowing problems may need softer foods. In these cases, a diet of pureed or liquidized foods may be needed.4

Unfortunately, soft food diets and textures are hard to define. Food preparations and types vary widely around the world. It is hard to make general statements about certain foods to include in a soft food diet.

Some scales of food and liquid thickness help understand slight texture differences. One example is from the International Dysphagia Diet Standardization Initiative (IDDSI). The IDDSI framework has 8 levels that range from thin liquids (level 0) to regular foods (level 7). People with no difficulty swallowing can have level 0 liquids and level 7 foods. People with more severe swallowing problems need level 3 to 4 foods and liquids. This helps doctors categorize foods based on each person’s specific needs.5

If you have questions about nutrition and diet needs, talk to your doctor.

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