Seasonal Feast: Summertime Cookout Ideas
Gathering with family and friends is a summertime cookout tradition while celebrating July 4th, Labor Day, or just the fact that the weather is beautiful and it’s time to be outside. Those suffering from dysphagia may be reluctant to attend or host a summertime cookout because of the perceived difficulty in enjoying those delicious traditional foods and liquids. We are going to walk you through typical summertime cookout foods and give you tips and techniques to make them safer for those with dysphagia who require an altered consistency.
Cookout Menu
Protein:
Hamburgers, Hotdogs/Sausage, Barbecue Chicken
Sides:
Potato Salad, Macaroni Salad, Grilled Veggies
Dessert:
Strawberry Shortcake, Ice Cream, Fruit Salad
Drinks:
Lemonade, Iced Tea, Milkshake
Hamburgers
The goal with the hamburger is to decide what type of beef you are going to use. As you are using a grill and the juices are going to fall through the grate, using a low fat beef is great, but not as vital with this cooking method.
Regular Consistency: Prepare as you normally would. If you have a dysphagia patient that fatigues while eating, consider foregoing the bun in order to make chewing one single consistency easier. Adding cheese to the hamburger would help with that cohesiveness.
Mechanical Soft: Prepare as you normally would. A hamburger is already a mechanical soft consistency. In order to make it more cohesive, put the ketchup and mustard on the bun or add cheese when cooking. Consider not adding the pickle relish or pickles, as they can separate and make it more difficult to contain in the mouth. Consider not toasting the bun as the softer bun will make this a more cohesive bite. Cut the hamburger up into four pieces to assist with taking small bites.
Puree/Soft – Making a hamburger puree is not usually a very good idea because the hamburger will retain a grainy consistency that is not pleasant to the palate. A substitute might be a liver pate’ or getting a Braunschweiger loaf at the deli counter and adding a little liquid such as beef broth before smashing it with a fork to a puree consistency. This gives the taste of beef with the safety of the puree.
*** Note that for all of the hamburgers, mince a cup of mushrooms and add to the ground beef. Add a touch of Worcestershire Sauce to the mixture and season as you normally do. This is intended to make them all a softer and more cohesive consistency as the mushrooms give a smooth texture when cooked and add moisture to the mix. There is not an added mushroom taste as it combines with the beef during the grilling process. I suggest using the white mushrooms as they tend to mix best.
Hotdogs/Sausage
When choosing hotdogs or sausages on the grill, one wants to consider fresh sausages from the deli counter as that will have a more moist consistency. Hot dogs come in all types and flavors and it does not seem to matter too much which you choose. Please remember that with hot dogs or sausages, the risk is that the food item is the same shape as the trachea and if someone aspirates a piece it can be difficult to dislodge. Therefore, no matter which of these that you consider, please be sure to slice them in half lengthwise before serving.
Regular Consistency: For the patient on a regular diet it is vital to cut in half lengthwise before serving just to be sure it cannot block the airway if accidentally aspirated. Using a non-toasted bun with an abundance of condiments is preferable. If adding pickle relish or sauerkraut it is suggested that you take small bites and chew well before swallowing.
Mechanical Soft: The safest way to consume either a sausage or a hot dog is by removing the skin. I would pick the sausage over the hot dog for the mechanical soft diet. Either way, be sure to not only cut lengthwise, but also in small pieces. I would consider not using the bun in this case and staying away from pickle relish and sauerkraut as they can be difficult to transit into the esophagus and have a propensity to leave residue in the pharynx which can be more difficult to clear. If you are the cook, consider buying some of the sausage in patties or bulk and cooking it with some cheese on top. This will be tasty and add some cohesiveness to the dish.
Puree/Soft – There is not a good way to make a hot dog or sausage a puree that has a great texture because of the grainy texture of each. I would stay away from this food item at the cookout.
Barbeque Chicken
Consider choosing chicken thighs as one of the chicken parts for the cookout. The chicken thigh is a more tender and juicer consistency than the chicken breast and is easier to manipulate for the patient with dysphagia. Marinating the chicken prior to the cookout is always a good idea to add the flavor and also begin to break down the texture prior to cooking. Using a vinegar based barbeque sauce might help with this tenderization.
Regular: For the regular diet it is important to assess the fatigue factor of the patient. If the patient gets tired from chewing during a meal, consider taking the chicken off the bone prior to eating. No one notices this technique and it saves a lot of energy in the long run. It is always a good idea to maximize energy at the cookout with friends and family in order to enjoy all of the fun!
Mechanical Soft: Making grilled chicken a mechanical soft diet simply requires taking the chicken off the bone and cutting it up into small pieces that are not big enough to block the airway if aspirated. Use your thumb as the guide as to the size of your trachea. The pieces should not be bigger than that diameter and the more irregular the pieces, the better. Be sure to put enough barbeque sauce on the chicken to keep it moist and help with the bites being cohesive. Do you load up your fork with too many pieces at once! One at a time is best. Chew the food well and consider shredding the chicken thigh meat rather than cutting it into pieces. This would give you the most safety, especially if you fatigue when eating. You can then put the shredded chicken barbeque on an untoasted bun with adequate barbecue sauce and eat this in small bites and pieces.
Puree/Soft: Pureed chicken has a tendency to be grainy and would not necessarily be comforting to the patient at a cookout. Consider the Braunschweiger alternative prepared as a ‘pate in this case.
When choosing sides such as potato salad, macaroni salad and grilled vegetables, be sure to consider the difficulty that each type of side will present. Alterations in texture do not mean alterations in taste and those without swallowing difficulties will not even notice. The whole point of a gathering is for everyone to enjoy, including those suffering from dysphagia!
Potato Salad
There are several options for potato salad. The important thing to consider for your guests with a variety of swallowing abilities is the texture of the components of the potato salad. If celery is a component, that invites more of a choking hazard than peas, for example. Take a look at the ingredients and then consider alterations in the components you choose.
For example, a southern potato salad traditionally has hard boiled eggs, potatoes and celery with mayonnaise or miracle whip, whereas a German potato salad has red potatoes dressed in a warm bacon, mustard and vinegar dressing without the texture of the celery. Substituting peas for the celery might do the trick in your southern potato salad if that is your choice.
Regular: Any potato salad recipe will be considered a regular texture. There are no alterations you need to make in texture for this consistency. Always look for fatigue, however, with a patient recovering from any illness or suffering a neurological disorder, and if it is present I would lean toward the softest of the choices, ie the German potato salad.
Mechanical Soft: Potato salad is typically considered a mechanical soft consistency only if the ingredients are cut into small pieces and have enough binding material such as miracle whip or mayonnaise, or a dressing to hold it together. If using hard boiled eggs, a soft boiled egg may blend better, and make sure the celery is cut into very fine pieces. For a German potato salad, assure that the bacon is cooked crisp and is finely cut into pieces so that it does not break away from the rest of the bite when taken. Giving the potato salad a few smashes with the serving spoon will help with the softness prior to eating.
Puree: A potato salad puree sounds suspiciously like mashed potatoes, so I encourage you to add mashed potatoes to your menu as an alternative. Supplying a gravy will only add to the softness and encourage the puree smoothness. Your other guests may surely love this addition as well and won’t point out the compensation that your dysphagia patient requires! The point of the cookout is to fit in. This tip helps with that.
Macaroni Salad
Macaroni Salad is a cookout favorite but can be tricky with dysphagia. The typical ingredients include elbow macaroni noodles, cheddar cheese, onion, celery, pepper, peas, mayonnaise or miracle whip dressing, apple cider vinegar and an herb such as dill. There are, however, alternatives to make this pasta dish appropriate for everyone.
Regular/Mechanical Soft: Macaroni salad is already considered a mechanical soft consistency. If you have a patient with dysphagia who tires throughout the meal, simply give the salad a small smash of the fork prior to eating. Also be aware of the size of the celery or other vegetables that you put into the salad so that they could easily be coughed out if aspirated. **Remember the ‘rule of thumb’, no piece should have the diameter of your thumb so that it does not block the trachea if aspirated! If your patient has been advised to be on a mechanical soft diet that is ‘mixed and moist’, you may consider substituting the macaroni salad with macaroni and cheese. The cheese helps hold the bite together and by cooking it an additional length of time, the pasta will become softer.
Puree/Soft: Substitute the macaroni salad with macaroni and cheese. Cook the pasta an extra 10 minutes or so to make it very soft and assure that your cheese is creamy. Prior to serving, smash the macaroni and cheese with a fork or potato masher and then stir to a smoother consistency. This tastes good, smells wonderful, and your other guests will enjoy the macaroni and cheese with their meals as well!
Grilled Veggies
Grilled veggies add that flair to a backyard barbeque. Picking the right vegetables for the patient with swallowing difficulties is key. Typically one might want to do a skewer of veggies with peppers, onions, and tomatoes, or an array of asparagus, broccoli, cauliflower, and zucchini. Any summer veggies taste better on the grill.
In order to accommodate your patient with dysphagia, however, let’s look at how the veggies break down when cooked. You will want a consistency that is soft and easy to chew without being stringy or having a tough or crunchy texture. This would eliminate the onions, peppers, broccoli and asparagus textures. Zucchini, cauliflower, squash, and potatoes, however, may be winners here. Any veggie that you can cook soft and smash with a fork as your test for safety, can be added to the cookout.
Regular: Any and all of the veggies mentioned are considered a regular consistency. If you have a dysphagia patient that fatigues when eating, stick to the veggies that are positive to the smash test as noted above. Those are always going to be safer and more enjoyable for the patient to chew and swallow.
Mechanical Soft: There are two things to consider with the vegetables when either choosing from vegetables offered at someone else’s barbeque, or creating one of your own bite size and ability to smash it with a light touch of a fork. Consider the difference between eating a piece of asparagus which is still stringy even when cooked soft, and a piece of zucchini. The zucchini (peeled) turns into a soft and smooth consistency. That’s what you want. Examples might be potatoes, squash, zucchini, cauliflower (only if it has a sauce on top such as cheese), or even carrots that are cooked till soft. Examples of vegetables not to consider might be corn, peppers, broccoli, or any vegetable that can break into little pieces when cut. For the patient who fatigues, a few smashes with a fork takes away the need to fatigue by chewing as it takes energy best kept for a strong swallow.
Soft/Puree: There is one easy obvious choice for a cookout vegetable – potatoes. If you are at another person’s cookout and they have baked potatoes on the grill, you have hit a home run in the safety department! It is a short trip from mechanical soft to soft/puree consistency with the addition of some butter and sour cream or milk. You can even prepare it in the potato skin by simply scooping out the potato, adding the sour cream, butter, and/or milk, using your fork to mix well, and attain a consistency like applesauce. As for the other vegetables, it may be difficult to smash them into a soft puree consistency, aside from squash. Squash can be scooped or smashed with a fork, adding some honey or maple syrup, or butter to get a smooth consistency.
Desserts are the easiest category of food to manipulate as so many already have smooth and cohesive textures. Perhaps the most versatile for summertime cookouts is strawberry shortcake with ice cream on top. Fruit salad can also be manipulated somewhat for variety as well.
Strawberry Shortcake, Ice Cream
The texture of strawberry shortcake with a scoop of ice cream is not always as intuitive as it seems. First let’s talk about the shortcake. The easiest texture of a ‘shortcake’ is an angel food cake. Homemade shortcake or biscuits can also be used but one has to consider the dryness of the texture and make up for it by adding liquids either in the strawberries or the ice cream to even it out. Angel food cake already melts in your mouth and has the perfect texture for manipulation for the dysphagia patient’s enjoyment. Next, prepare the strawberries in a way that is consistent with the texture needed and you are good to go.
Regular: To accommodate a regular diet the strawberries should be cut into slices rather than whole. Even if the dysphagia patient is appropriate for a regular diet, fatigue can increase risk of a piece of the strawberry falling into the airway. As such, use your ‘rule of thumb’ to assure that coughing it out is possible without an extreme amount of effort. The shortcake is not important in this diet as any will suffice. If there is any strawberry juice in the bowl, add a little to the top of the strawberries and shortcake, and even on top of the ice cream. It will make the consistency for any diet more palatable and easy to chew and swallow.
Mechanical Soft: The strawberries should be cut in half vertically before slicing to assure that the pieces are small and easy to chew. Once all the strawberries are cut, and if the diet permits added sugar, sprinkle with white or brown sugar in order to create a strawberry juice. Give the strawberries a smash with either a serving fork or potato masher in order to create a texture that is more cohesive and delicious! Choose the shortcake that is also cohesive, considering the angel food cake, and scoop the strawberries onto the slice of cake. Top with ice cream if permitted by diet, and then top with a little additional smashed strawberries and juice. Let sit for a few minutes to soften the cake and enjoy.
Soft/Puree: The strawberries should be prepared as in the mechanical soft consistency, however prior to serving, utilize a hand held immersion blender to smooth out the strawberries into a puree consistency. This does not alter the taste of the strawberries while eliminating the choking hazard of the strawberry pieces. If necessary, add a little cornstarch or dietary thickener to create a mousse-like consistency. Cut a piece of angel food cake and scoop the strawberry mousse onto the cake and let it soak in. Smash the cake with your fork, assuring that no crumbles exist in the mixture.Top with a scoop of ice cream. As an alternative you could mix the strawberry mousse-like consistency with the ice cream prior to topping onto the angel food cake. Make sure to let the dessert sit for a few minutes before serving to let the angel food cake become cohesive with the rest of the dessert. It should mimic a mashed potato or thick applesauce consistency as an example of texture.
Mixed Fruit
A mixed fruit dessert can take a few different paths to safety with dysphagia. Depending on the types of fruit that you wish to include, one has to consider the water content. Please remember that when you are on an altered diet, the texture of the food also takes into consideration how much liquid flows from the fruit. For example, if you are eating a fruit cocktail and you are capable of chewing and swallowing the peaches or pears without issue, the syrup within which it sits can be another issue. That is considered a thin liquid and having two consistencies at once can be very very difficult to swallow. You may have heard your therapist say that you need to be careful of ‘mixed consistencies’… this is what they are talking about. Let’s see what we can do at the cookout with typical fruits and their consistencies.
Regular: Fruits that are normally in the mixed fruit bowl at a summertime cookout include watermelon, cantaloupe, grapes, strawberries, pineapple, apples, and maybe a mango or other fruit of this variety. The fruits are typically cut up into pieces and/or the watermelon is served in slices. None of these fruits should present an issue aside from the grapes if served whole in the fruit salad. If your patient is recovering from a surgery or medical event, the fatigue when eating the meal may make grapes an issue as, remembering the ‘rule of thumb’, they are a dangerous size for the airway. I would simply eliminate the grapes from my scoop of fruit salad and enjoy!
Mechanical Soft: Making a fruit salad mechanically soft simply requires cutting the pieces into small bite sized pieces. Unless the patient has been cleared to eat a mixed consistency diet that includes fruit and juice, one needs to be careful with all of the fruits and be sure not to scoop up the liquid into the bite. I would also either cut the grapes into quarters, or eliminate them completely. The bite size should not be bigger than the diameter of your thumb as we have discussed previously. Assure that you chew the fruit thoroughly and that you take small bites while you enjoy the refreshingly summertime treat!
Soft/Puree: Fruit salad typically does not smash or mix well with a fork or spoon. The texture can be grainy and a mixture of thin and thicker liquids when combined. An alternative would be to take some of the fruit and ice cream and make a milkshake or smoothie with the immersion blender. Assure that it is at least a milkshake consistency by not adding additional liquid to the mix. You might have to play with this a little to get the consistency that you want. For example, watermelon and cantaloupe are going to mix thinner than apples and pineapples. Getting a good mix will only enhance the flavor, but the texture as well! If you are at another person’s barbeque, then ice cream is always a good choice!
Drinks: Lemonade, Iced Tea, Milkshake
Outdoor cookout drinks are not only tasty, but the hydration they provide is important when out in the heat and the sun. Typical drinks at a cookout may be lemonade, iced tea or even milkshakes as a special treat. The important thing to consider is that the consistency of the liquid helps the food to go down safely, while hydrating and nourishing. Let’s consider the different consistencies and what you can do to satisfy those recommendations while enjoying the cookout!
Regular/Thin Consistency
Any of the liquids mentioned above can be considered a regular/thin consistency. When you add ice to the drink it becomes even thinner as time passes while enjoying the cookout. Using a straw may or may not be recommended by your Speech Pathologist, and that would also carry to any setting in which you are eating. You may want to carry your own Tervis Tumbler or cup with a lid on it. It not only helps control the sip size, which may have been recommended by your Speech Pathologist, but it keeps the bugs out of your drink! It’s a win-win!
Nectar Consistency
If you were recommended for a nectar thick consistency when eating food, remember that it is also important at a cookout. With Lemonade or Iced Tea, you may have your little portable packets of liquid thickener with you. No one will notice that you add it to your drink as it will look like a sugar packet, if you get embarrassed by your dysphagia. Simply add the packet of thickener (or 2 if it is a very large tervis tumbler or glass) and stir ‘with your fork’. This is important as the fork agitates the thickener and breaks it up into the liquid, thus thickening it to the proper consistency. If your Speech Pathologist recommended a straw, that is fine. If not, that should be honored in this setting as well. Small sips, alternating foods and liquids, helps clear out the pharynx for the next bite.
If you are choosing the Milk Shake, you need only to put it into your glass and enjoy as that is appropriate for this consistency! Even if it melts considerably, the ice cream and milk mixture should still be appropriate with this nectar consistency.
Honey Thick Consistency
To make a Lemonade or Iced Tea into a honey thick consistency, you will need to have your packets of liquid thickener with you. Sprinkle the thickener into the glass ( or 2 if using a large tervis tumbler or glass), stir with your fork to agitate the thickener and break it up into the liquid, and let sit for approximately 5 minutes or so. At this time, test to see if the liquid has thickened up. Typically it will begin to thicken within a few minutes. The acid in the lemonade may take a little longer, but resist adding more thickener as you can then end up with a paste-like consistency if you add too much. You should be able to drink this with the lid on your glass, and if not, take the lid off.
If you are choosing a Milkshake, ensure that the ice cream is firm and that your milkshake ends up in a honey thick consistency. Be aware that if your milkshake begins to melt, consider eating the thick parts with a spoon and assure that the lid is on the cup to ingest the rest as it will help control the sip of the thinner milk shake. If possible, refresh your milkshake with new contents to thicken it up if it melts too much.