Swallowing Difficulties

We've provided guidance below for some swallowing difficulties including the swallowing of food, liquid and medication as well as advice around common saliva issues.

If you notice swallowing becomes harder - such as more coughing, choking or struggling with foods or drinks that are usually managed, please contact our team on (01372) 735574.

If there is a serious choking incident, or if swallowing suddenly gets much worse, please call 999. For urgent medical questions, please contact NHS 111- they are available 24 hours a day.

Please see NHS advice on symptoms and treatment of chest infections.

Problems swallowing drinks or liquids

There are many causes of swallowing problems. Listed below is some general advice that may be helpful as you wait for an assessment.

If using this advice reduces difficulties, it may mean you do not need a swallowing assessment. Please contact the team on (01372) 735574 if you think this may be the case.

Positioning/ Environment

  • Make sure the person is fully awake and alert.
  • Make sure the person is sitting as upright as possible (sometimes using a cushion behind the back helps). If in bed, or on a soft seat, a slumped posture can make swallowing less safe.
  • Try to keep the head in a central position and avoid tipping the head back, or leaning to the side.
  • Reduce distractions in the environment e.g. consider turning off the television.
  • Avoid chatting to someone whilst concentrating on eating or drinking.

 

Mouthful size

  •  Small, single sips are generally safer than large mouthfuls.
  •  Avoid ‘glugging’ liquids. Take single mouthfuls and take the cup away from lips between each.
  •  If short of breath, wait for breathing rate to settle before drinking, with time between each mouthful to recover.

Equipment

  •  Wide-brimmed open cups or Kapi-cups (nosey cups) can be useful as these encourage a neutral head position.
  • Avoid using lidded beakers, medicine cups, sport-type bottles, drinking straws and tall or narrow cups.

 

Support

  • Support the person to be as independent as possible but provide help as needed. Sometimes, giving hand over hand support with a cup helps.
  • If help is needed, ensure there is a good lip seal and the person is ready before tipping the cup. Observe carefully the amount that is given in each mouthful and remove the cup between sips.
  • It may take longer to finish a drink if taking single sips, so leave plenty of time.
  • Allow plenty of time between mouthfuls if extra swallows are needed.

 

Coughing

  •  Coughing is a natural protection mechanism to help stop saliva, food and drink from going into the lungs.
  •  If drinks are making someone sound ‘gurgly/ bubbly’, or they are doing lots of throat clearing, encourage them to have a big cough and re-swallow to clear.
  •  If there is gurgling or coughing with food or drink, stop at that point and encourage good clearance. Only restart when clear.
  • If any of these symptoms increase since referral and you are concerned, please contact your GP or out of hours medical support on 111, as appropriate. Please also let the speech therapy team know on 01372 735574.

 

Teeth/ mouth cleaning

One of the best ways to support someone with swallowing problems is to ensure that mouth health (gums, lips, cheeks, teeth, tongue) is as good as possible. This can include seeing a dentist regularly but also brushing teeth/ gums/ tongue 2-3 times a day. It is often the bacteria that we naturally hold in our mouths that can increase the risk of chest infections in people who have problems with swallowing.

Problems swallowing food

There are many causes of swallowing problems. Listed below is some general advice that may be helpful as you wait for an assessment.

If using this advice reduces difficulties, it may mean you do not need a swallowing assessment. Please contact the team on (01372) 735574 if you think this may be the case.

Reflux

Sometimes, issues with stomach acid and problems with foods moving down our gullets towards our stomachs can impact our swallowing. Sometimes, the symptoms of this may not be ‘heartburn’, but other symptoms like throat clearing, coughing when lying down, or hoarse voice in the mornings. If you have been prescribed medication to help with these issues, please make sure it is taken regularly and that you follow NHS advice.

 

Positioning/ Environment

  • Make sure the person is fully awake and alert for the duration of the meal. Pause eating if they become less awake, and start again once alert. You may need to keep a diary of the amount of food taken.
  • Make sure the person is sitting as upright as possible (sometimes a cushion behind the back can help). If in bed, or on a soft seat, a slumped posture can make swallowing less safe.
  • Try to keep the head in a neutral position and avoid tipping the head back, or leaning to the side.
  • Reduce distractions in the environment e.g. consider turning off the television.
  • Avoid talking to someone whilst concentrating on eating or drinking.
  • If short of breath, wait for breathing rate to settle before eating, with time between each mouthful to recover.
  • Ensure all glasses, hearing aids and dentures are in for all meals.

 

Chewing & Clearing the Mouth

  • If concerned about choking, consider avoiding high-risk foods (dry, crumbly, chewy, fibrous, hard and bread-like products). Sometimes keeping a food diary can help identify problem foods, problem timings or other issues. For example, is it more likely to happen at the end of a meal, or when eating on the sofa?
  • If problems with chewing, consider choosing easy to chew foods (for example, shepherd’s/ fish pie is easier to swallow than a roast dinner), and /or moister foods. You could add extra sauce/ gravy.
  • Make sure the food given is liked and looks and smells as normal as possible.
  • Ensure that no food is left in the mouth after meals, with support for mouth care as appropriate.

·       If someone is holding onto food in their mouths:

    •      Talk about the food including tastes and smells.
    •       Strongly flavoured foods may increase taste and improve swallowing for some people.
    •       Provide short prompts e.g. ‘big swallow’
    • Use a teaspoon so their mouth isn’t overfilled

 

  • An empty spoon against the lips/mouth may prompt the person to swallow food still in their mouth.
  •  Complete oral care to remove any food residue from the mouth after eating.

 

Pacing and speed

  • Eating and drinking safely may take a long time, so plan time for this.
  • Control the pace so the person does not overfill their mouth. Swallowing can be slow to trigger in some people and they may try to take another mouthful before swallowing the first.
  •   Ask them to swallow a second or third time if needed (without extra mouthfuls, but to clear food left behind).
  • A sip of drink might help some people to clear the food residue in their mouth/ throat

 

Coughing

  • Coughing is a natural protection mechanism to help stop saliva, food and drink from going into the lungs.
  • If drinks are making someone sound ‘gurgly/ bubbly’, or they are doing lots of throat clearing, encourage them to have a big cough and re-swallow to clear.
  •   If there is gurgling or coughing with food or drink, stop at that point and encourage good, strong coughs. Only restart when clear.
  • If any of these symptoms increase since referral please contact your GP or out of hours medical support on 111 as appropriate. Please also let the speech therapy team know on 01372 735574.

 

Teeth/ mouth cleaning

One of the best ways to support someone with swallowing problems is to ensure that mouth health (gums, lips, cheeks, teeth, tongue) is as good as possible. This can include seeing a dentist regularly but also brushing teeth/ gums/ tongue 2-3 times a day. It is often the bacteria that we naturally hold in our mouths that can increase the risk of chest infections in people who have problems with swallowing.

Problems with saliva

Adults produce up to 1.5 litres of saliva a day and often need to swallow every minute or so to control it. In many diseases, this reflex to swallow saliva is reduced and therefore there is a build-up in the mouth.

  • Try to take regular sips of fluid to help ‘wash’ the saliva down.
  • Make a conscious effort to swallow. A reminder alarm system may be helpful in prompting you to swallow. Try and increase the habit to always swallow before talking or getting up out of a chair.
  • Try to sit as upright as possible. If you are reading, chatting, or watching the television, make a conscious effort to close your mouth and lips tightly when possible.
  • If your saliva is thick, try drinking pineapple juice to thin the saliva. Also, try drinking more water throughout the day to help thin your saliva.
  • Brush your teeth/dentures and tongue two times a day to reduce bacteria.
  • When at home, consider wearing a neckerchief to keep your skin dry.
  • If you have a very dry mouth, having regular sips of water and using synthetic saliva sprays or gels can also help (discuss with GP).

 

Teeth/ mouth cleaning

One of the best ways to support someone with swallowing problems is to ensure that mouth health (gums, lips, cheeks, teeth, tongue) is as good as possible. This can include seeing a dentist regularly but also brushing teeth/ gums/ tongue 2-3 times a day. It is often the bacteria that we naturally hold in our mouths that can increase the risk of chest infections in people who have problems with swallowing.

Problems with swallowing tablets & medication

It is very common for people to have difficulties swallowing tablets/ medications, particularly as you get older. An assessment from a speech and language therapist is not indicated if this is your only problem.

Most types of pills are designed to be swallowed whole.  Chewing, breaking, or crushing them can change how the medication is digested and absorbed into the body. This change can affect the way a medication works and increase the chance of side effects.  Those with trouble swallowing medications should speak to their doctor and/or pharmacist for advice or to ask for different forms of medications e.g. liquid forms.

Never cut or crush tablets, open capsules, thicken medicines or add to food without advice from your pharmacist or GP.