5 Clinician-approved tips for swallowing safely
Check out my recent blog post, which originally appeared on the Constant Therapy blog, BrainWire.
Dysphagia, otherwise known as disordered swallowing, can impact people who have had a stroke, a traumatic brain injury, or other neurological or neuromuscular disorders like Parkinson’s or Multiple Sclerosis. When we swallow, there are three major phases that speech-language pathologists (SLPs) and occupational therapists (OTs) usually think about — the oral phase, when we put liquid or food in our mouths and prepare it to go down our throat; the pharyngeal phase, when the muscles in our throat work together to move food safely down through our throat and into our esophagus; and finally the esophageal phase, when our esophagus pushes foods and liquids into our stomach.
These three phases require coordination and strength, and if the nerves or muscles that take part in any of those stages of swallowing are impacted, a person can be at risk of aspiration (when material like saliva, liquid, or foods goes down the trachea and into the lungs instead of down the esophagus and into the stomach), which can cause pneumonia. Check out this cool video to see how cleverly our bodies protect our airways and get food safely into our stomachs!
Looking for a few tips to maximize your swallow safety in the New Year? Read on!
Tip #1 – Follow your diet recommendations
“Diet recommendations,” doesn’t mean cutting back on sugar. This refers to the textures and consistencies of the foods and drinks that are recommended for you or your loved one’s specific dysphagia difficulties.
The best way to determine dysphagia challenges and appropriate diet consistencies is to have a swallow study done. There are a few types of swallow studies that can be done; one is called a fiberoptic endoscopic evaluation of swallowing (FEES), when a speech-language pathologist or an ear/nose/throat (ENT) doctor passes a thin, flexible tube with a tiny video camera up your nose and down your throat to watch the swallow happen. Another is called a modified barium swallow study (MBS), a video x-ray where a speech-language pathologist or radiologist might give you foods and liquids to eat and drink that have barium in them so that they show up on the x-ray. Based on these studies, a speech-language pathologist or occupational therapist may recommend specific types of foods and drinks for you or your loved one that are safest for them to eat and drink.
If you have diet recommendations such as “nectar thick liquids” or “mechanical soft foods,” it’s important to follow those recommendations, as those are the consistencies of foods and drinks that your loved one is safely able to swallow. There are thickening powders and pre-made drinks out there to make liquids nectar or honey thick consistencies – the thicker a liquid is, the slower it moves, giving you more time to prepare for and execute the swallowing process, so often thicker liquids may be recommended. Lumpier textured foods are harder to chew and then form into a bolus (a collection of well-chewed food, moistened by saliva and then gathered together) to safely swallow, so often softer or even pureed foods may be recommended. You can process foods beforehand with a blender to make them easier to eat – blending apples into applesauce or potatoes into smooth, mashed potatoes are a few examples.
Tip #2 – Use your compensatory strategies
If you’ve had a swallow study done or worked on dysphagia with an SLP or OT, you may have had some specific compensatory strategies recommended based on you or your loved one’s needs. Make sure you follow those, whether they’re using a chin tuck or taking a clearing swallow of water following each bite of solid food. Keep reading to learn some general compensatory strategies that are helpful for just about anyone.
Tip #3 – Think about bite size
The first part of the oral phase of our swallow is getting our bite or sip ready, and when we do that, we need to think about size! Make sure that you or your loved one are taking reasonably sized bites and sips so that you’re able to safely get all the food or liquid past your trachea and into your esophagus. For many people with dysphagia, it is important not to take overly large bites, as that makes it harder to safely swallow. There are some situations where slightly larger bites may be helpful – it’s important to check with your therapist to make sure you’re taking the right-sized bite for you or your loved one.
Tip #4 – Slow down
When we slow down and think carefully about each step of swallowing, we are much more likely to fully clear all the food from our mouth and get it safely down our throat and into our esophagus. We also want to make sure we get all the food from the previous bite safely down before taking on any more food or drink.
Tip #5 – Narrow your focus
If you or your loved one is having a hard time eating or drinking safely, they may need to take a step back and focus on one thing at a time. Eating and drinking are often social events, but for someone with dysphagia, it may be so effortful for them to swallow safely that they need to focus ONLY on swallowing, and might need to take a break from the conversation while they are eating or drinking. This might mean tuning conversation out for a moment, or even eating or drinking in a separate, quiet room.
BONUS TIP – Visual supports!
Do you have a loved one who has a hard time remembering their compensatory strategies? Make them a quick, picture-reminder card that they can have at their place at the table! Something as simple as a little snail picture to remember to slow down, or even pictures of your loved one demonstrating their compensatory strategies can be SO powerful! It also can save you having to verbally remind your loved one to use their strategies in front of company – you can just quietly point to the picture as a reminder, rather than having to say anything aloud.