Dysphagia (swallowing difficulties)

Eating, drinking and swallowing are complicated activities. Lots of muscle groups must work well together and in the right order to swallow.

People with dysphagia may have trouble swallowing liquids, food or sometimes their own saliva.

How we swallow

Swallowing has 4 stages:

• Choosing and bringing food and drink to the mouth.
• Biting, chewing and preparing food in the mouth ready for swallowing. The tongue and jaw move food around the mouth to chew it, mix it with saliva 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. This prevents food or drink entering the lungs. The food pipe (oesophagus) opens to direct food towards the stomach.
• The food or drink enters the oesophagus and moves down into the stomach.

Some people 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 maintain a healthy weight, particularly during growth spurts. Depending upon others to assist you at mealtimes can affect how much you have to eat and drink. 

Signs of dysphagia

The list does not cover all the signs and symptoms of dysphagia. If you are worried, seek advice from a medical professional about:

• not putting on weight
• 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 people with these difficulties 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
• chest infections

Eating with dysphagia

A speech and language therapist or dietician can help if your child is having difficulties with their swallowing. They will ask you questions and watch your child them eat and drink to consider what might affect mealtimes. The speech and language therapist will often make recommendations based on this. Sometimes, they might refer you for further investigations or treatment.

Positioning

An occupational therapist or physiotherapist working with the speech and language therapist can advise on the best positioning for eating and drinking. This may include special seating that keeps the feet, body and head well supported. It’s difficult to eat and drink with your head tilted back or your body moving around. You may need to reposition several times during a meal.

Textures of food

Sometimes changing the texture of food and drink can make it easier and safer to swallow.

Your dietician or GP can prescribe a thickening agent to help with swallowing. Some people may need their food to be soft, cut up, mashed or puréed to help them bite, chew and swallow it safely. Your speech and language therapist can help you decide which textures may be most suitable.

Supplements

People who have tight muscles (spasticity) or are constantly moving (athetoid CP or autism) 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.

Following cues

If you are helping 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.

Tube feeding

Where swallowing is very difficult, or where someone is at risk of illness or not growing well, professionals might suggest tube feeding.

Tube feeding