See your doctor immediately if you notice any of the following symptoms:
- Coughing while eating or drinking.
- Food falling out of the mouth and drooling.
- Voice changes after liquid intake.
- Choking on certain foods.
- Frequent throat clearing.
- A sensation of residual food in the mouth or throat and having to swallow several times.
- A sensation of cervical obstruction.
- A temperature of 38º or more for no apparent reason.
Measures to ensure safe swallowing:
- Being wide awake and oriented at meal times.
- Eating small amounts of soft and lubricated foods.
- Eating slowly and without distractions (avoiding television, talking, etc).
- Drinking liquids in small amounts (never through a straw).
- Being properly seated (back at 90º for at least 30 minutes).
- Scrupulous oral hygiene.
A. Modify the consistency of foods and drinks
Modifying the consistency of foods and drinks to make them softer will greatly reduce the risk of choking and of respiratory tract infections by preventing food from going into the lungs rather than the stomach.
When swallowing solid food is difficult:
- Break up food into small pieces. If you do this just before eating it will ensure flavour and other properties are better retained.
- Strain prepared foods to ensure that they have a uniform texture and to remove any lumps, bones, strands, etc.
- Avoid fruits and vegetables with seeds that cannot be removed (kiwi, strawberries, etc) and foods that crumble in the mouth (cake, buns, etc).
- Do not add more liquid than necessary to soften food to avoid affecting nutritional value.
- Do not serve soups with noodles or rice without first passing them through a liquefier to reduce the risk of choking.
- Add sauces or milk to soften foods and enhance taste.
When swallowing liquids is difficult:
- Add a thickening agent, available from drugstores or pharmacies.
- Strain liquids with solid residues (e.g., orange juice) that might stick to the throat, or simply avoid them.
B. Ensure a balanced diet
- Eat foods that contain animal and vegetable proteins, e.g., meat, fish, eggs, milk and legumes.
- Eat foods that are rich in fibre, as this promotes intestinal activity and avoids constipation, e.g., vegetables, fruits and whole grains.
- Eat plenty of fresh fruit and vegetables for their important vitamins and minerals.
- Avoid adding too much water or liquid to purees that might reduce the nutritional value of the food.
- Serve small portions of nutrient-rich dishes, bearing in mind that people with dysphagia usually lack appetite.
- Drink 1-1.5 litres of liquid daily (water, juices, infusions, etc) to avoid dehydration.
C. Make food appealing to the eye, smell and taste
- Swallowing difficulties lead to a lack of interest in food and loss of appetite.
- Prepare dishes so that they are attractive to the senses.
- Shape foods (e.g., purees) using moulds or pastry bags.
- Ensure a varied menu.
Tips for caregivers of dependent persons
1. Serving small quantities
Avoid foods that might result is an enlarged bolus in the mouth. Wait until the previous mouthful has been fully swallowed before putting more food in the mouth. Use smaller tea/coffee spoons rather than larger soup/dessert spoons.
2. Ensuring a correct posture
Ensure the patient is in an upright position, with no possibility of rolling to the side or falling backwards. One way to keep the head from tilting to the side is to use a U-shaped travel cushion.
3. Placing food in the mouth
Sit comfortably, directly facing the patient so they are not forced to turn or bend their head.
Place the spoon in the middle of the tongue and press slightly downwards. A trick to improve the swallowing reflex is to touch the lower lip with the very cold tip of a spoon. Avoid trying to do several things at once.
4. Avoiding distractions
Ensure that the patient is fully focused on eating, avoiding any distractions that might take their attention off their food.
Dietitian’s tips and tricks
- Proper oral hygiene is essential to prevent microbes from reaching the lungs.
- Treatment consists, as a minimum, of thoroughly brushing the teeth and other mouth surfaces (tongue, palate, etc) once a day (morning or night) and using mouthwash twice a day.