Pureed (IDDSI Level 4)
Completely smooth foods/extremely thick liquids with no lumps that hold their shape on a spoon and don’t require chewing.
Birthdays should still include birthday treats. For a child with dysphagia, though, traditional cake can present several challenges. Cake and frosting can become sticky or form a dense paste in the mouth, while sprinkles, candies and other decorations add small, harder pieces that aren’t appropriate for a modified texture. This Birthday Cake Custard brings some of those familiar birthday cake flavors into a smooth dessert designed for IDDSI Level 4 Pureed and beyond.
Making Custard Taste Like Birthday Cake
There isn’t actually any cake in this recipe. Cake, along with bread and other baked goods, is one of the most surprising choking risks for people with difficulty chewing and swallowing. (Learn more about why and how you can modify to keep bread on your menu) Instead, whole milk, egg yolks and butter create the rich custard base, while vanilla and an optional tiny amount of almond extract provide that familiar “birthday cake” flavor. The result is still a real dessert, just one whose texture is much easier to control and test.
Smooth From the Start
Custard is particularly useful for Level 4 because it can be prepared without needing to puree a finished dessert. The ingredients cook into one smooth, cohesive consistency, and straining the finished custard helps remove any small pieces of cooked egg or other lumps. For Level 4, the finished custard should be completely smooth with no lumps, hold its shape on a spoon without being firm or sticky, and pass the IDDSI Fork Drip and Spoon Tilt Tests.
What About Sprinkles?
Traditional sprinkles aren’t appropriate for a Level 4 puree, but that doesn’t mean the dessert has to look plain. I separate out portions of the custard and add food coloring, allowing you to add designs. You can also try decorating with small amounts of smooth fruit puree. It can be piped, dotted or swirled onto the custard for some birthday color while maintaining an appropriate texture. Just remember that the finished dessert, including its decorations, still needs to meet the child’s prescribed texture requirements. So keep that strainer handy to catch any seeds or skins for the fruit puree. For a party, individual colorful cups or ramekins can also make the dessert feel special without adding anything to the food itself.
Test It Cold
This recipe is intended to be served chilled, so test it chilled. Custard thickens considerably as it cools, meaning a mixture that passes the IDDSI tests while warm may behave very differently after a few hours in the refrigerator. Before serving, stir the custard well and perform the Level 4 tests at its actual serving temperature. If it has become too thick or sticky, adjust the consistency as needed and test again.
Make this Recipe for Your IDDSI Level
As written, this recipes is at IDDSI Level 4 Pureed . This recipe can also be adapted for Level 3 Liquidized, Level 5 Minced and Moist, Level 6 Soft and Bite Sized, and Level 7 Easy to Chew. See the adaptation instructions below or if you are printing the recipe, they will be included in the notes section.
Level 3 Liquidized (Smooth enough to drink or pour; no chewing): Blend, slowly adding milk until it moves when poured at a pace of 2 mL per 10 seconds (check out the flow test details).
Level 5 Minced and Moist (Soft pieces that fit between fork prongs in a puree; minimal chewing): Enjoy as written; if adding any fruit, be sure to mince to <2mm and fold into custard, avoiding skins and seeds.
Level 6 Soft and Bite Sized (Tender pieces smaller than the width of fork prongs): Enjoy as written, dice any added fruits to <8mm, being sure to look out for any separate thin liquids.
Level 7 Easy to Chew (Foods that are soft and easily bite into pieces): Enjoy as written, adding your favorite soft nonfibrous fruits.
Birthday Cake Custard Pediatric Recipe
Ingredients
Equipment
Method
- Heat milk in a saucepan until steaming but not boiling. In a bowl, whisk egg yolks, sugar and cornstarch together until completely smooth.
- Slowly whisk approximately 1/2 cup warm milk into the yolks. Gradually whisk the tempered yolk mixture back into the saucepan. Cook over medium-low heat, whisking continuously, until thick and completely smooth.
- Remove from heat and whisk in butter, vanilla and optional almond extract. Pass through a fine-mesh strainer to eliminate any cooked egg or other lumps. Chill until serving.
- Stir thoroughly before testing. If refrigeration has made the custard too firm or sticky, whisk in a small amount of milk and retest. Perform the Level 4 Fork Drip and Spoon Tilt tests at the actual serving temperature.
SLP Notes
IDDSI Texture Modifications:- Level 3 Liquidized (LQ3): Blend, slowly adding milk until it moves when poured at a pace of 2 mL per 10 seconds (check out the flow test details).
- Minced & Moist 5 (MM5): Enjoy as written; if adding any fruit, be sure to mince to <2mm and fold into custard, avoiding skins and seeds.
- Soft & Bite-sized 6 (SB6): Enjoy as written, dice any added fruits to <8mm, being sure to look out for any separate thin liquids.
- Easy to Chew 7 (EC7): Enjoy as written, adding your favorite soft nonfibrous fruits.
A Birthday Treat Everyone Can Recognize
Modified texture food doesn’t need to turn a celebration into a completely different experience. This custard isn’t intended to imitate the texture of cake; it’s meant to offer the sweet, buttery vanilla flavors associated with birthday cake in a form designed around the child’s swallowing needs. Serve it in a favorite cup, add an appropriate smooth decoration, put a candle nearby, and it can still clearly say: this is the birthday dessert.
Related Recipes
Looking for a meal to serve at your child’s party? Check out the burger and fries hash bowl pediatric recipe. Or are you looking for more adult flavors for your pureed dessert? Dig into the espresso panna cotta recipe.
Every recipe here is designed for texture sensitive eaters: from dysphagia to dental issues to picky eaters. Get recipe roundups and practical tips by joining the mailing list.
