Swallowing

Sometimes people notice a change in their ability to swallow certain foods or fluids. They might feel that food or drinks are 'going down the wrong way'. Signs of swallowing difficulties may include: coughing when eating or drinking, choking, a ‘gurgly’ voice after swallowing, or the feeling of food or drink sticking in the throat. Aspiration is when food or fluids go into the airway and lungs, instead of the stomach. Aspiration can lead to serious problems, such as weight loss, frequent chest infections and admission to hospital.

Speech and language therapists work as part of a large team supporting people with eating, drinking and swallowing difficulties.

The speech and language therapist will look particularly at the ‘oral’ and ‘pharyngeal’ stages of eating and drinking – involving your mouth and throat. This typically involves looking at the muscles of your mouth and throat and observing you eating and drinking. They may also ask you to carry out specific exercises during the assessment to better understand how the muscles used for swallowing are working together.

After the initial assessment, the therapist may refer you for further assessment, such as an x-ray of your swallowing (videofluoroscopy) or an endoscopic investigation. To help with your swallowing difficulties, they may recommend:

Swallowing exercises to improve the function and safety of your swallow
Adapting your posture when eating and drinking
Adapting your pacing when eating and drinking
Changing the texture or consistency of food and drinks.

They may also advise that other health professionals be involved in your care too, such as dietitians, nurses or physiotherapists.

The table below gives some information about how other people in the team may be able to support you. You don’t need to see a speech and language therapist before seeking help from these professionals if you are having difficulty. Speak to your GP if you are not sure how to be referred to any of these services.

Professional	Area of Need
GP	Resource thicken up clear prescription Medication review/ alteration End of life feeding decisions/ risk feeding decisions Medication for drooling
Pharmacist	Adapted medications
Dietitian	Food fortification Supplements
Oral Care Specialist	Training and assessment for oral condition
Dentist	Dentures and problems with dentition
Physiotherapist	Mobility and safe positioning
Occupational Therapy	Provision and support with safe seating and other tools of independent living
Nestle	Resource thicken up clear provider. Their representatives offer staff training and resources to support using thickener safely and effectively in care homes

IDDSI (International Dysphagia Diet Standardisation Initiative):
In 2019, a new international framework was introduced to create consistency in the terminology used to describe food and drinks. This helps to improve safety when caring for people with swallowing problems. You can find out more information on the IDDSI website.

These diets are often recommended for people with swallowing difficulties. They follow the IDDSI descriptors, and are approved by the Royal College of Speech and Language Therapists.

Level 4 puree diet booklet, PDF
Level 5 minced and moist diet booklet, PDF
Level 6 soft and bite-sized diet booklet, PDF