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.

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.

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.

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.

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.

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.

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 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.

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 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.

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.

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.

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.

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.

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!