Header photo courtesy of American Speech-Language Hearing Association, Adult Dysphagia: Assessment.
Did you know it takes more than 40 pairs of muscles and 8 nerves to move food from the mouth to the stomach? [i] While the process of swallowing food appears to be quite simple to the average person, it’s actually a complex system of several steps that must occur in the right order and at the right time. When one step fails, a swallowing disorder can occur.
Some might think of a swallowing difficulty as being food or liquid “going down the wrong way.” However, for someone with dysphagia, a swallowing disorder is entirely different, and can even be life-threatening.
For example, when a person lacks strength, control, or feeling in the mouth, food or liquid can fall into the throat before the swallowing reflex is triggered. The swallowing reflex may be delayed, incomplete, or absent altogether. As a result, food can become trapped within the natural recesses of the pharynx. The larynx might not lift or close, or abnormal muscle contractions can fail to move food along. [ii] This is called aspiration, which can lead to coughing, difficulty breathing, discomfort, and sometimes choking. [iii]
Individuals living with dysphagia are at risk of aspirating whenever they eat foods or drink liquids, therefore food consistency remains a critical component of the dysphagia diet.
Precise tongue control is required to gather and hold the liquids against the roof of the mouth until the swallowing reflex is triggered. Thicker liquids help keep these individuals hydrated, while lessening the risk of aspiration. [iv]
Consider these additional tips to help reduce or prevent aspiration, provided by the Hartford Institute of Geriatric Nursing: [v]
- Provide a 30-minute rest period prior to feeding time; a rested person will likely have less difficulty swallowing.
- During mealtime, sit the person upright in a chair. If the individual is confined to a bed, elevate the backrest to a 90-degree angle.
- Adjust the rate of feeding and size of bites to the person’s tolerance, and avoid rushed or forced feeding.
- Alternate solid and liquid boluses (textures).
- Vary placement of food in the person’s mouth according to the type of deficit. For example, if the patient has facial weakness on the left side, food may be placed on the right side of the mouth.
- Work with a trained dysphagia clinician, such as a speech therapist, to determine the food viscosity and dysphagia diet most appropriate for the individual. Thickened food and liquids are commonly used to promote safer bolus transit (swallowing) and better airway protection. [vi]
- Monitor and record the amount of fluids consumed, and encourage fluid intake by offering fluids between meals as well as during meals.
Using these guidelines and finding products specifically made for modified diets can ensure success for those with dysphagia.
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