Swallowing Problems by
Clare Morris, Speech & Language Therapist, Prion Group, St. Mary’s
Hospital London
SWALLOWING PROBLEMS
- How to Help
Cough
A cough is the body's response to 'foreign bodies' entering the airway
or windpipe. It is our way of protecting our lungs from getting clogged
up and interfering with breathing. It is under neurological control and
can therefore be affected in dementia. The important thing to understand
is that if someone can cough when you ask them to, it doesn't
necessarily mean they will cough to clear their windpipe. Likewise, if
someone is unable to cough on request, it may be that they will have an
adequate 'protective' cough.
Aspiration
Aspiration is when liquids or food do go down the wrong way and are not
removed by coughing.
Below are listed some
common problems and strategies used to facilitate swallowing. It is,
however, recommended that the advice of a speech and language therapist
is sought, as strategies recommended will vary according to the stages
of the swallow affected and the client. You can obtain a referral
through your GP, or if necessary contact your local hospital or the
Royal College of Speech and language Therapists for information on
services locally. Other professionals, such as a dietician, occupational
therapist, physiotherapist, or district nurse, may need to be involved.
Common problems that you
may notice:
- being unaware of food
when it arrives
- failing to do
anything with food in the mouth, just holding it there
- difficulty chewing
and/or difficulty moving food to the back of the mouth
- spitting lumps of
food out
- eating very fast or
putting too much into the mouth
- eating insufficient
amounts or refusing food and/or drink
- talking with food or
drink in the mouth and forgetting to swallow causing coughing
- coughing/choking on
food and /or liquids
- complaints of food
not going down or getting stuck in their throat
- a 'wet' or 'gurgly'
voice after swallowing
- difficulty swallowing
tablets
- dribbling
- chronic chestiness or
recurring chest infections
Ways to promote safe
eating that may be suggested by a speech and language therapist
Strategies
- Sitting upright,
keeping the chin down. If you put your head back to drink, you are
opening up the airway more, therefore if the swallow reflex is slow,
it is easier for food and drink to go down the wrong way.
- Take small sips of
drink, perhaps from a teaspoon. Avoid the use of drinking vessels
that encourage the head to tip back (eg feeder beakers)
- Take small mouthfuls
of food.
- Alternate food and
drink to help clear the mouth of food: this should be discussed with
a speech and language therapist.
- Try encouraging the
swallowing of each mouthful twice to clear any food or drink that
may remain in the mouth or in the throat after the first swallow.
- If the person has not
swallowed what is in their mouth, sometimes it helps to present an
empty teaspoon rather than more food. This can encourage the second
swallow mentioned above.
- Frequent swallows to
counteract dribbling.
- Check mouth after
finishing eating to ensure no food or fluid remains.
- ou may have to sit
with the person to remind them to use these strategies, and you may
find that mealtimes take much longer.
Changes to diet
- Special diets (soft
or puree), merely avoiding certain foods, or preparing them
differently can make a big difference. Foods that may present
difficulty for someone with a swallowing problem include:
a) mixed textures eg food in a lot of fluids like ministrone soup,
or cornflakes and milk;
b) stringy textures eg bacon, cabbage, runner beans
c) floppy textures eg lettuce, cucumber
d) small, hard textures such as peanuts, peas, sweet corn and broad
beans
Cooking food longer so it becomes softer; mashing food with the back
of a fork; or liquidising it in a blender can help.
- Thickening fluids to
yoghurt or sometimes porridge consistencies may help as they are
easier to control. There are a number of thickening agents available
through your GP or from a dietician. It is important to speak to a
speech and language therapist about this, and it can also be helpful
to have guidance in using thickeners as the fluids may become lumpy
which does not look appealing and may be off putting!
- The use of
nutritional supplements if necessary.
- Crushing tablets or
using a syrup form may be easier for someone with a swallowing
problem but seek advice from your GP as some tablets need to be
taken whole.
Equipment
- Specially designed
cups which allow drinking whilst keeping the chin down
- cutlery, plates and
non slip mats are available. An occupational therapist can advise
you on this.
Sometimes these
strategies may be insufficient to ensure an adequate dietary intake.
After discussion with your doctor it is may be decided to feed via a
tube directly into the stomach. This is called a gastrostomy, and it can
be used in conjunction with eating small amounts orally, or can be used
alone.
Food and eating is
central to living in terms of pleasure and socialising as well as
survival, therefore eating and swallowing problems have a major impact
both on the person directly affected and those caring for them. It is
possible to compensate for many difficulties, and support and guidance
from a speech and language therapist can make the difference.
Information about
dementia and speech and language therapy services is available from:
- C.A.N.D.I.D
(Counselling and Diagnosis in Dementia)
The National Hospital for Neurology and Neurosurgery
Queen Square
London WC1N 3BG.
Tel: 0171 837 3611 ext 3855
Fax: 0171 209 0182
E-mail: c.morris@candid.ion.ucl.ac.uk
- The Royal College of
Speech and Language Therapists
7, Bath Place
Rivington Street
London EC2A 3DR
Tel: 0171 613 3855
Fax: 0171 613 3854
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