Problems with swallowing can result from a variety of medical conditions including Parkinson’s Disease, Cerebral Palsy, stroke, or head injuries. If you have difficulty swallowing, your doctor may refer you to a Speech Language Pathologist for an evaluation and to learn things you can do to make sure you are able to eat and drink safely, including changing the consistency of the foods you eat and drink.
Problems with swallowing are more than just an annoyance. Our bodies need food and water to survive. People who have difficulty swallowing can easily become dehydrated and poorly nourished. Difficulty swallowing can also pose a risk that food or liquids will “go down the wrong way” and cause choking. Since problems swallowing are often caused by damaged nerves or weakened muscles in the mouth and throat, people with swallowing problems also may not be able to cough effectively to clear food from the airway. Liquids that get into the lungs can cause infections including pneumonia.
Swallowing Liquids
Swallowing is a complex process that involves over 50 pairs of muscles in the mouth and throat. In order for swallowing to be successful, liquids are caught by the tongue and worked to the back of the mouth. Nerves and muscles work together when you swallow to close the airway and move liquid down the esophagus into the stomach. For people with difficulty swallowing, the tongue is not able to catch the liquid when it enters the mouth and move it to the back where it can be swallowed. To help this process, your doctor may instruct you to drink only thickened liquids. Water and other standard drinks have a very thin consistency. Your doctor may prescribe liquids that are the consistency of nectar (like tomato juice), honey-thick, or even as thick as pudding, depending on how much difficulty you are having with swallowing. A variety of products are available that can be added to liquids to create the correct thickened consistency.
It’s important to remember that if you are instructed to drink thickened liquids, you should never drink through a straw. The straw bypasses the tongue and deposits liquids at the back of the mouth. If you have difficulty swallowing, this can make you more likely to choke or have the liquid go down the wrong way.
Swallowing Solids
If you have difficulty chewing food, your doctor may also instruct you to eat only foods that have been pureed or run through a blender. While this may seem like eating “baby food” it is medically important to do what the doctor instructs. If the muscles in your mouth and jaws are weakened, you may be unable to chew your food completely. This poses an even greater choking risk when there are difficulties with swallowing. Some people with swallowing difficulties also “pocket” some of the food they eat. This means some of the food sits in the cheeks instead of being completely swallowed after each bite. If this happens, your doctor may recommend that you alternate between bites of food and swallows of liquids to help clear the mouth and reduce the risk of choking.
No Substitutions
It’s very important to follow all your doctor’s instructions about eating and drinking, even though it may be less pleasant to have to drink liquids that are thickened or foods that are pureed. It’s also important for family members to recognize that changing the consistency of food and liquids is part of the care prescribed by the doctor to help the patient remain healthy and regain strength as quickly as possible. Solid foods and thin liquids should not be substituted until the doctor says it’s safe for you to have them based on continued evaluations of your ability to swallow.
Sources:
American Speech-Language-Hearing Association
National Institutes of Health