Swallowing is a complicated activity. Lots of muscle groups must work well together and in the right order to get food or drink, past the lips and to the back of the mouth. People with dysphagia may have trouble swallowing liquids, food or sometimes their own saliva.
How we swallow
Swallowing has 3 stages:
Preparing food in the mouth ready for swallowing. The tongue and jaw move food around the mouth to chew it and make it into a ball.
Pushing the ball of food and drink to the back of the mouth and into the throat (pharynx). During this stage, our airway closes to prevent food or drink entering the lungs and the food pipe (oesophagus) opens direct food towards the stomach.
The food or drink enters the oesophagus and moves down into the stomach.
People with cerebral palsy (CP) may have difficulty organising the muscles in the mouth, lips and tongue to work at the right times and in the right order for swallowing. This might mean that they are at risk of food and drinks going down into the airway (aspiration) during mealtimes. Aspiration can lead to problems with chest health such as pneumonia.
Even people with mild difficulty may not be able to eat enough to grow well, particularly during growth spurts.
Signs to look out for
The list does not cover all the signs and symptoms of dysphagia. If you are worried, seek advice from a medical professional about:
difficulties getting food into the mouth from a spoon or cup. Some people have a bite reflex. This causes them to bite down hard onto cutlery.
difficulty bringing lips together and keeping them closed. Often these people have a lot of saliva and may dribble or drool.
difficulties chewing food
coughing or choking when eating or drinking
changes in a person’s breathing when they eat or drink. They may breathe faster or their breathing might start to sound noisy.
signs of stress such as pulling away, eye widening or tears when eating
refusing food at mealtimes
What can help
A Speech and Language Therapist can help if your child is having difficulties with their swallowing. They will watch them eat and drink and can often make recommendations based on this. Sometimes, they might refer you for a videofluoroscopy. This is a moving x-ray that looks at how your swallowing works. This test gives a clearer picture of what is happening when someone eats and drinks. Not all people will need this procedure.
If you are needing to help someone to eat and drink, it’s important to follow their cues at mealtimes. Give them:
choices of what they eat or drink and in what order
time to chew and swallow
your full attention
Mealtimes are much more than a method of providing calories. They give a good opportunity for enjoying communication and social interaction.
An Occupational Therapist or Physiotherapist can advise on the best position for eating and drinking. This includes having our feet, body and head well supported. It’s difficult to eat and drink with your head tilted back. You may need to reposition people several times during a meal.
Textures of food
Sometimes changing the texture of food and drink can make it easier and safer to swallow. Thick drinks rather than thin juice or water may help to give more control when swallowing and reduce the risk of aspiration. Sometimes your GP can prescribe a powder, which thickens all drinks, to ease swallowing. Some people may need their food to be soft, cut up, mashed or puréed to help them chew and swallow it safely. Your Speech and Language Therapist can help you decide which texture will be best to try.
People who have tight muscles (spasticity) or are constantly moving (athetoid CP) use up far more energy than other people. This means they need more food to grow and keep healthy. Sometimes prescribed supplements can help keep up someone’s calorie intake.
Where swallowing is very difficult, or where someone is at risk of illness or not growing well, professionals might ask you to think about tube feeding.