Hard to Swallow

“Don’t speak with your mouth full.”

When we were children, this advice saved us from bad table manners.  For anyone with swallowing or speech difficulties, this advice can be life-saving.  Swallowing problems or choking episodes can lead to pneumonia or more dire consequences.  

When our loved ones have swallowing problems, meal time can be terrifying.   A few basic safeguards can help alleviate the risks and the terror:

• Eating or drinking should occur only while the individual is in a sitting position.  Those who cannot sit upright should be placed in as high a sitting position as possible, a minimum of 45 degrees or in a side-lying position.  No one should eat or drink anything while lying flat on their back. 
• After eating meals or snacks, individuals should remain in an upright position for 30-60 minutes to prevent reflux of stomach contents which can lead to tissue damage to the esophagus.  (This is true for all of us – not simply those with swallowing or health problems.)
• Food should be eaten in small mouthfuls.
• All foods should be well chewed.  Meat should be cut into small pieces and chewed thoroughly before swallowing.  Meat and vegetables can also by pureed in a blender for severe swallowing problems.
• Each mouthful should be swallowed before more food is placed in the mouth.  Encourage the individual to take an extra, empty swallow to completely empty the food passageway.
• Solid food and liquids should not be mixed in the mouth at the same time.
• Meals should be eaten at a slow pace.
• Talking and chewing at the same time is high-risk behavior -- and increases the risk of developing gas after meals.

Thicker fluids also decrease the risk of choking.  Food thickeners can be added to any liquid to increase the viscosity to a nectar or honey-like thickness, depending on how much is added.  These products can be purchased at pharmacies and retail stores without a prescription.  (Before you use these thickeners, consult your physician.)

Medications should never be crushed or melted for ingestion without first asking the physician or home care/hospice nurse, because the effectiveness of the medication can change if the form is altered.  Putting medications into food or fluid is risky; unless the food or fluid is completely consumed there is no way to determine how much of the dose was actually given.   

If swallowing difficulties or choking episodes occur or continue, talk with your loved one’s doctor about other recommendations.