Eating and drinking is a complex activity involving lots of different nerves and muscles. Our breathing control is very important too. For health, it is important to drink enough fluids and have a diet that contains enough nutrients. Good nutrition is important for recovery from illness.
If you have recently had a diagnosis of COVID-19, you may have trouble with eating and drinking due to:
- General fatigue and weakness which can impact greatly on your chewing, swallowing and ability to eat.
- Spending time in ITU and requiring a breathing tube/ventilation to help you breathe can result in swelling and discomfort in your throat which may affect your ability to eat and drink normally. You may have also had a feeding tube placed if you were ventilated.
- Weak swallowing muscles - When we eat and drink, we use lots of nerves and muscles which can become weaker over time if they are not being used. If you did not eat and drink for a prolonged period of time in hospital, your swallowing muscles may have become weaker.
- Reduced appetite - This may be caused by the physical or psychological impacts of coronavirus. For example, anxiety, taste and smell changes, swallowing difficulties and gastrointestinal disturbances such as vomiting, diarrhoea and constipation may result in reduced appetite. Reduced appetite can result in weight and muscle mass loss
Some sources provide guidance on diet plans, e.g. a low histamine diet to manage symptoms of Long COVID. At the moment, there is no evidence base to support this advice. It is important to note that these diets are very restrictive, and could potentially lead to nutritional deficiencies, making your symptoms worse. Following a balanced diet, with a variety foods from each of the main food groups as shown by the Eatwell Guide is recommended. Any restrictive diet such as this should be carried out under the supervision of a registered Dietician.
Eating and drinking whilst in hospital
If you have been in hospital, you should have been:
- Weighed regularly
- Offered regular meals and snacks
- Offered regular nourishing drinks including prescribed nutritional supplements
If you were unable to eat in hospital for whatever reason (e.g you were placed nil by mouth or required a breathing tube for ventilation) you may have had a feeding tube in place.
You may have been referred to a Dietitian if there were nutritional concerns whilst you were in hospital.
If there were swallowing concerns whilst you were in hospital you may also have been referred to a Speech and Language Therapist.
If you have been assessed by a Speech and Language Therapist during your hospital admission you may have been given advice about how to make eating and drinking easier, such as having softer foods or thickening your drinks. If needed, you may have been given a program of exercises to help strengthen your swallow.
About to be discharged home?
When you go home, it may take some time for your appetite and oral intake to return to normal. If you had swallowing issues in hospital, you may continue to have ongoing swallowing issues at home.
You should be discharged home with: -
- A 2 week supply of nutritional supplements.
- A Nutrition Discharge Pack (separate from this booklet).
The nutrition discharge pack should allow you to continue maximising your nutritional intake at home independently or with the support of your family/carers.
If you have/ developed high potassium, high phosphate or have chronic kidney disease stage 4 or 5, you may not have received this nutrition discharge pack but you should have had individualised advice from a Dietitian instead.
- A supply of thickener if you require thickened fluids on discharge.
Eating and drinking at home
The nutrition discharge pack contains a variety of resources to help with nutritional recovery at home after being diagnosed with coronavirus. This pack includes:
- A Nutrition checklist- to allow you to assess your own nutritional risk
- “Building yourself up” – a booklet focusing on food first approaches to maximise nutritional intake
- Basic store cupboard ideas
- Additional help booklets and leaflets within your local area
- “Eating well” – Tips for monitoring your weight and tips for a healthy balanced diet
- “Improving your nutrition” – Tips for monitoring your progress and tips for eating when you are short of breath, have a dry/sore mouth or have taste/smell changes.
- “Nutrition Support” – Tips on taking oral nutritional supplements
If you have reduced interest in food or you are low in mood:
- Try and eat with other people within your household if this is an option
- Think about how the food is presented, for example do you have a preferred plate or cup?
- Choose meals based what you feel like eating that day.
Look after your mouth
This is very important if you are having difficulty eating and drinking and also if you have had any help with your breathing if you were in hospital. The use of breathing masks and tubes can cause your mouth to become very dry which can encourage more bacteria to develop.
Regular mouth care is important to help prevent infections and dryness.
What else can you do?
- Ask friends and family members to help with meal preparation.
- Make sure that when you are eating and drinking, you aren’t distracted.
- If you usually wear dentures, make sure you wear them when you eat and drink and ensure that they are fixed if needed.
- When you are eating and drinking, posture is really important. Sit in a chair which supports your back, so you are in an upright position with your feet on the floor or supported on a flat surface. Sit facing forward with your chin level or slightly down. Do not tip your head back as this makes it more likely that drinks will go down the wrong way. If you are not able to sit in a chair, make sure you are as upright as comfortably possible.
- When you are eating and drinking, make sure you clear each mouthful before taking another.
- If you are tiring easily when eating and drinking, opt for foods that are moist and easy to chew (see table overleaf for examples).
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Meal time
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Food option ideas
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Breakfast
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Instant oats/ Porridge
Wheat bisks soaked in milk
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Lunch/ evening meal
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Cottage pie
Steamed fish in sauce or Fish pie
Macaroni cheese
Omelette or scrambled eggs
Jacket potato (no skin)
Tender meat casserole or Corned beef hash
Very soft cooked pasta with sauce/ lasagne
Well cooked vegetables e.g cauliflower cheese, turnips, swede.
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Dessert ideas
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Smooth yoghurts
Instant whip or mousses
Crème caramel
Sponge pudding with cream/ custard
Bananas
Skinned peaches or apricots or pears
Stewed apples
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Some foods are particularly difficult to swallow and may be best avoided if you are finding eating is more difficult, these include:
- Stringy, fibrous foods – pineapple, runner beans, celery, oranges, lettuce
- Crunchy foods - toast, crisps, flaky pastry, crispy chips, batter.
- Crumbly foods – biscuits, crumble, crackers
- Mixed consistencies that separate out e.g. cornflakes with milk, thin soup with lumps in
- Hard or chewy foods e.g. nuts, seeds, chewy sweets, hard boiled sweets, crusty bread.
- Foods with a husk e.g. sweetcorn, broad beans.
Remember that you use the same muscles for eating and drinking as you do for speech and voice. You may tire easily if you speak a lot prior to eating (and also vice versa).
- If you feel that things are sticking in your throat, swallow again without putting anything new in your mouth.
- If your voice sounds a little gurgly or wet after swallowing, do a little cough to clear and then swallow.
- Do not lie down straight after eating or drinking, as this can cause coughing if there is any bits of food or fluid still in the throat. Aim to stay in an upright position for at least 20 minutes after eating or drinking.
Ongoing support required?
- If you become concerned about reduced appetite/oral intake or your weight reduces at home, contact your GP and ask them to refer you to our Dietetic service.
- A Speech and Language Therapist may have spoken to you about whether you need further support from the department if you have been in hospital. Please contact your GP if you have any new concerns or ongoing difficulties with your swallowing. Your GP may refer you to Speech and Language Therapy for advice or assessment if indicated.
Please contact your GP as a matter of urgency if you notice any of the following:
- Coughing or choking at mealtimes or when drinking.
- Change in breathing pattern after eating or drinking.
- Pain or discomfort on swallowing.
- Frequent chest infections.
- Food getting stuck in the throat