Any burn survivor is in need of a high quality diet as soon as possible
after the burn, continuing for a long time after the incident. The child or
adult needs far more protein and fluid than they might normally have. Many
children who are burned, come from extremely poor homes and have not been well
fed in the months or years before the accident.
For children like Dorah who have had facial burns, it can be very
difficult to ensure that they get enough to eat at all. Loss of lips make it
difficult to keep food in, and to chew and swallow properly.
In Southern African hospitals it cannot be assumed that nursing staff
are aware of the child's dietary needs at this crucial time. The charity will
assist with high protein food supplements if asked.
The information below is provided by Luise Marino, a British dietician
who works extensively with paediatric burn victims at hospitals in the Durban
area of South Africa.
A puréed diet is essentially a "normal" diet, which is made into
a smooth consistency, which is easier to swallow or administer via a
Some foods such as yoghurt/ custard may be at the correct consistency,
other foods need to be pureed using a liquidiser, food processor, or hand
Some foods are easier to puree than others and the following guidelines
will give you some ideas.
Meat and Poultry:
Minced meat and poultry is often easier to
puree in slices. It may be necessary to add extra gravy or stock to reach the
Fish without bones and skin may be pureed, with a
white, cheese or tomato sauce.
Eggs are a good source of protein, as are meat and
fish. Savoury egg custards, cheese puddings and scrambled eggs are a few
suggestions. Eggs should always be thoroughly cooked before they are eaten.
It is best to use whole milk, unless you are otherwise
advised. You should aim to use a least 500ml of milk per day, which can be used
in soups, mashed potatoes, sauces, milky drinks and custards.
Cheese is a nutritious and versatile food, which can
be the main part of a meal, e.g. pureed cauliflower cheese, or cheese sauce
with pureed vegetables or fish.
Beans, Pulses and Lentils:
These are alternative source of
protein to meat and poultry. Cooked lentils puree well. However, beans such as
kidney beans, and chickpeas, have tough skin which may not puree well;
therefore you will need to puree the beans and sieve them.
Most well-cooked vegetables can be pureed easily
and should be included to form part of the well balanced diet. Care must be
taken to ensure that vegetables are evenly pureed and that no lumps, skins etc.
remain. Tomatoes are not suitable because of the seeds.
These DO NOT puree well and should be excluded from the
These should be included with the diet, as they are
filling and nutritious. Boil and them cream the potatoes, adding margarine and/
or grated cheese and/or milk to increase the nutritional content. Instant
mashed potato is an excellent quick alternative, made more nourishing by making
up with hot milk instead of water.
This is also filling and nutritious and purees well.
Pasta with a sauce e.g. pureed macaroni cheese, is a suggestion.
Advice for People with Swallowing Problems
Some cereals can be included within a puree diet
e.g. porridge, weetabix. Other cereals such as Bran, Bran Flakes and Weetabix
require pre-soaking with milk or cream to form the correct consistency.
Occasionally the fluid and solid part of a pureed meal may separate e.g. with
vegetables. Foods can be thickened to prevent this from happening by using
cornflour, ground rice, mashed potato, instant potato powder, instant sauce
granules and custard powder.
Swallowing difficulties can be a side effect of many problems. Dysphagia
is the medical name for a swallowing problem, which may be short or long
term.Many people with dysphagia find thin liquids are difficult to swallow and
cause coughing, spluttering and even choking. This could give rise to chest
infections. Thickened drinks are often needed for safer swallowing.
Why must I drink?
We all need to drink some liquid to prevent
dehydration. If you have dysphagia, then your drinks may need to be thickened,
but it is still important that you have an adequate intake - ideally at least
8-10 cups per day (approx 1.5 litres).
A Speech and Language Therapist can help you if you have swallowing
difficulties as they are trained to assess your ability to swallow and will
determine the thickness of drinks and consistency of foods that you are able to
A Speech and Language Therapist will also advise you on:
- The best sitting
position and posture to make swallowing easier.
- Certain techniques
to aid swallowing.
He or she should assess you regularly, as the thickness of the drinks
may have to be adjusted according to the changes in your condition.
What is a thickened drink?
Drinks can be divided into 3 categories according to consistency.
'Thin Drinks' which may be thickened include: Water, tea, coffee, fruit
juice, hot chocolate.
'A slow moving drink' is any liquid which is smooth and poured easily
e.g drinking yoghurt, double cream (before whipping), canned tomato soup and
cartons of pouring custard.
'Thick Drinks' are smooth liquids that appear semi-solid e.g.
milk-shakes bought from burger take-aways, where the straw stands up on its
own. There are a few thick drinks readily available in the shops, e.g. French
set yoghurt (stir well before drinking) and home made thick custards suitable
for trifles. Slow moving and thick drinks probably need no added thickener.
A thickened drink can be made by mixing a thin drink with a food
thickener e.g. Thick n' Easy, Nestargel. You can thicken any thin drink, but
some of them will give better result than others . The quantity of thickener to
add depends on the drinks used and the type of thickener. Guidelines are given
on each tin of thickener.
How can I check whether a drink is 'thick' or not?
check of the correct consistency is the 'straw' test; if a straw will stand up
on its own in a cup of fluid, it is a thick drink. If the straw slowly 'falls'
to one side, you have a slow moving drink.
NB: Milk shakes can be of different consistencies, depending of their
ingredients. Milk shakes made from milk and syrup are thin drinks. Milk shakes
with ice-cream and puréed fruit can be 'slow moving' or 'thick'
depending on the quantity of thickening ingredients added. The straw test will
help you to determine whether the thickness of the drink is suitable for
Soft and Puréed Foods:
In addition to thickened
drinks, soft, pureed or liquidised foods are often necessary in order to
provide you with a balanced varied diet.
Try to include the following:
- 3 small meals
a day, as well as 2-3 nutritious drinks between meals.
- Use at least
one pint of full cream milk or high fat Mass per day.
- Meat, fish,
chicken, well cooked eggs, cheese, yoghurt, beans or lentils at least twice
- One serving
of bread, potatoes, pasta, rice, cereal or maize meal with each meal.
- Fruit and vegetables
daily. Drink a glass of juice if little fruit has been taken.
- Use plenty
of sugar in drinks and puddings.
- Use plenty
of butter, margarine, cream, skimmed milk powder or evaporated milk in dishes.
- Most foods can
be adapted to make them suitable. A liquidiser is useful but not essential,
a potato masher or hand Mouli works just as well.
foods separately to keep the flavours and colours. Serve different coloured
foods to add interest e.g savoury mince, puréed carrots, mashed potatoes.
Puréed tinned peaches and custard.
- Some foods may
need thickening. Useful thickening agents are flour, cornflour, arrowroot,
ground rice, semolina, custard powder, blancmange, instant potato, breadcrumbs,
weetabix or use a food thickener.
- If foods need
thinning, do not add water, as this does not add any nutritional value. Milk,
cream, evaporate milk, butter, ice-cream, custard, sauces and meat gravy are
foods are often very useful, e.g. tinned/packet custard & milk pudding.
Foods that may be difficult to swallow:
Here is a guide for foods that may cause problems for some people.
Hard boiled eggs, pith of orange and grapefruit segments, chunky raw or
lightly cooked vegetables, celery, lettuce, cabbage stalks, peas, beans,
sweetcorn, chunky soup, outer part of roast meat, tough meat, new white soft
bread, crusty white bread, nuts, raisins, skin of fruit, dried fruit, breakfast
cereals, dry biscuits, thick porridge, dry mashed potato.
Ideas for suitable soft foods.
Remember to try and include as much variety of foods as possible to help
to provide you with a balanced diet. It is important to remember that plenty of
'moisture' is needed. e.g. gravy, sauce or custard.
flaked fish in sauce
puréed fruit (no skin)
jelly made with milk (milk jelly)
||Fish / mince
/ cheese lasagne
Ideas for suitable puréed foods:
- Poached, tinned
or flaked fish in a sauce, e.g. parsley, cheese, tomato sauce. Ensure there
are no bones.
NB: A thickener can be added to these to aid swallowing.
The most obvious way to increase your nutritional intake is to eat more.
This is often difficult when you are ill so you need to look at other ways of
adding extra nourishment to your food. These are adding nourishment to everyday
foods and taking snacks in between meals either as food or as nourishing