Grilled Cheese and Pickle Sandwich IDDSI Level 4

When we imagine a delicious grilled cheese and pickle sandwich we think of its crisp, crunchy and chewy nature. We hope that when we take a bite the cheese will have that wonderful stringy texture. The aroma will be strong and the flavour of caramelised bread and cheese will be intense!

The texture of foods for dysphagia diets means that crisp, crunchy, chewy and stringy are sadly out of the question. However we can deliver great flavour and aroma that can evoke the pleasures of eating a well made grilled cheese sandwich.

Big flavours

This recipe showcases techniques, that we use, to deliver a powerful flavour and aroma impact in foods for dysphagia diets. It is also a great opportunity to explore how texturisation can be used to reduce the stickiness of starchy purees.

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Reform Processes: Finely Process and Texturise



Toast Puree

100g White Bread

450g Whole Milk

Onion Pickle Puree

500g Onions

50g Oil

50g Sandwich Pickle

Grilled Cheese Puree

300g Strong Cheddar Cheese (feel free to use your favourite cheese here)

300g Double Cream

100g Full Fat Milk

1g Carrageenan Iota

Store Cupboard Ingredients


Full Fat Milk

Food Thickener

Reform Processes


Toast and Onion Pickle Puree

  1. Finely process the toasted crumbs with the milk until it is completely smooth
  2. Finely process the caramelised onions with the pickle until it is completely smooth
  3. Texturise by mixing the toast puree with the onion pickle puree
  4. Texturise the toast and onion pickle puree to the correct consistency so that it passes the IDDSI Fork Drip and Spoon Tilt tests

Grilled Cheese Puree

  1. Finely process the cheese and cream mix so that it is completely smooth
  2. Texturise the cheese infused cream to the correct consistency so that it passes the IDDSI Fork Drip and Spoon Tilt tests



To make the Toast and Onion Pickle Puree:

  1. Start by making the toast puree: Blend the bread to a fine crumb and bake in a hot oven, 200C, until dark golden brown in colour.
  2. Return the toasted crumbs to the blender, add the milk and finely process until fully incorporated and the mixture is completely smooth.
  3. The toast puree should pass the IDDSI Fork Drip test but will be too sticky to pass the IDDSI Spoon Tilt test. If the mixture is too firm, let down with a little more milk.
  4. Transfer the toast puree to a bowl and cover with clingfilm. Ensure the clingfilm touches the surface prevent a skin from forming.
  5. To make the onion pickle puree: Slice the onions and caramelise, in the oil, in a heavy based frying pan over a medium heat. This may take 10-15 minutes.
  6. Once the onions are dark golden brown transfer to a blender, add the pickle and finely process until completely smooth.
  7. Mix the toast and pickle purees together to finish the toast and onion pickle puree, which will no longer be sticky.
  8. Carry out the IDDSI Fork Drip and Spoon Tilt tests and texturise with the addition of food thickener or milk as required.

To make the Grilled Cheese Puree:

  1. Grate the cheddar and spread evenly on a silicon sheet.
  2. Bake in the hot oven until golden brown and bubbling. Remove and allow to cool.
  3. Place the cream and milk in a good sized pan, break up the now set baked cheese and stir into the mixture. Bring to a simmer over a moderate heat.
  4. Immediately the mixture starts to simmer, remove from the heat and set aside to allow the grilled cheese flavour to infuse.
  5. When cooled, strain the mix through a fine sieve to remove any pieces of cheese.
  6. Return to a pan, season to taste, whisk in the Carrageenan Iota and bring back to the boil.
  7. Once boiled pour the mix into a bowl and leave to cool.
  8. Whisk the cooled and thickened grilled cheese puree and check the consistency using the IDDSI Fork Drip and Spoon Tilt tests.
  9. If required, texturise by thickening or thinning down to the correct consistency.

Serving Suggestion: Layer the purees to resemble a sandwich on a plate or dish.

IDDSI Audit – Use appropriate IDDSI Level 4 – Pureed Audit Sheet

IDDSI Testing Methods:

No lumps
IDDSI Fork Drip Test
IDDSI Spoon Tilt Test

Note: The sandwich will not be able to be picked up.

Quality Audit: 5/5

Nutrition – 1/1
Flavour – 1/1
Colour – 1/1
Smell – 1/1
Composition – 1/1


Audit and serve the food at a temperature of 30C.