Dysphagia – swallowing disorders
Dysphagia – swallowing disorders
Our speech and language therapists assess, diagnose and manage swallowing disorders (known as dysphagia) associated with acquired neurological disorders, stroke, head injury, palliative care and respiratory disorders.
Our aim is to identify people who are at risk of aspiration (inhaling food or fluid into the airway) and to ensure that your eating and drinking is safe and sufficient. It is helpful for us to be involved in your care at an early stage as we can contribute to the diagnosis and management of swallowing difficulties.
We provide information about the results of assessments, agreed oral intake any appropriate swallowing strategies.
Referral
You can self-refer into our service by contact the Speech and Language Therapy admin hub on 01274 221166, or ask another professional involved in your care to refer you. For both self and professional service referrals please use the referral form below.
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If food or drink enters your airway (trachea) rather than travelling down towards your stomach (via the oesophagus) you may observe:
- coughing or choking before, during or after eating or drinking
- changes in breathing, eg: wheezing or shortness of breath
- wet or ‘gurgly’ voice quality after eating or drinking
- changes in facial colour, turning red, grey or blue
- eyes watering.
Other acute signs of eating and drinking difficulties can include:
- fatigue during a meal
- increased length of mealtime
- significant changes in eating or swallowing foods/liquids
- complaints of discomfort or food getting stuck
- difficulty clearing the mouth, food spilling out of the mouth, reduced chewing
- change in the amount/consistency of saliva
- chronic signs (become evident over a period of time)
- repeated chest infections (particularly of the right lung)
- weight loss
- general ill health – urinary tract infections, dehydration, pressure sores
- reduced appetite, food avoidance or refusal
- behavioural changes associated with mealtimes
- requires support to maintain oral health
- requires support for feeding
- changes in positioning for eating and drinking (slouching, head tipped back, leaning to
one side).
Please inform or refer to the Speech and Language Therapy team if these signs are observed
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If you are supporting someone who is waiting for a swallowing assessment, please follow these routines for feeding safely:
- Consciousness – no-one should be given food or drink if they are unconscious or semiconscious. Alternative nutritional and hydration options should be discussed with the responsible clinician.
- Distraction – reduce distractions at mealtimes to facilitate concentration and awareness.
- Time – allow adequate time to support the individual to eat and drink.
- Positioning – people should sit upright for all snacks, meals and drinks. People should remain sitting upright for at least 30 minutes after a meal to avoid reflux.
- Oral hygiene – ensure the mouth is clean and free from residue at the end of the meal. Encourage a ‘clearing swallow’ or ‘saliva swallow’ to assist in clearing residue from the mouth. Cleaning teeth and the mouth at intervals during the day is recommended.
- Position yourself – at eye level so that you may observe signs of food and drink going down the wrong way (aspiration) as well as being able to provide verbal prompts and encouragement. Positioning yourself above eye level or sitting at the side of individuals to assist with eating and drinking may have a negative impact on the individual’s ability to swallow safely as they may change their posture.
- Utensils – ensure you have the correct utensils identified for the individual.
- Dentures – if dentures are worn, ensure they fit well. Be aware that some individuals prefer to eat without their dentures and softening the diet may help.
- Glasses – swallowing requires multisensory stimulation. Food should be visually appetising in its presentation and smell appealing to stimulate the appetite.
- Hearing aids – ensure that the individual can hear the guidance and advice being given eg: when prompted to slow down.
- Modifying diet – ensure the correct consistencies of food and drink are prescribed for the individual with dysphagia.
- Independence – individuals should be encouraged to feed and drink themselves to encourage and maintain functional independence.
- Portion size – people who are frail or lack stamina should be given small portions which require less energy to eat (e.g. softer and/or more moist foods). These small portions of food or drink should be given at more frequent intervals in the day. The Dietician should be asked to advise if a patient/client is losing weight.
- Size of mouthful – It should be sufficient to stimulate chewing and swallowing but it is important to avoid overlarge mouthfuls.
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The International Dysphagic Diet Standardisation Initiative (IDDSI) is the official framework used internationally to provide a common way of describing food and drink thickness, in order to improve the safety of people with swallowing difficulties. We use this framework in the resources below.
IDDSI Level three – Preparing foods for a liquidised diet
IDDSI Level three – Liquidised diet information sheet
IDDSI Level four – Preparing foods for a pureed diet
IDDSI Level four – Pureed diet information sheet
IDDSI Level five – Preparing food for a minced and moist diet
IDDSI Level five – Minced and moist diet information sheet
IDDSI Level six – Preparing soft and bite-sized food
IDDSI Level six – Soft and bite-sized diet information sheet
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The International Dysphagic Diet Standardisation Initiative (IDDSI) is the official framework which provides a common way of describing food and drink thickness, in order to improve the safety of people with swallowing difficulties. We use this framework in the resources below.
IDDS Level two – Information on mildly thick fluids
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