Swallowing Difficulties (Dysphagia)
Understanding swallowing difficulties and how they can be managed safely
Swallowing difficulties, also known as dysphagia, can make eating and drinking more challenging. Some people may cough or choke while eating, feel that food is sticking, or find it difficult to swallow certain foods or drinks.
Speech and Language Therapists (SLTs) are specialists in assessing swallowing problems and helping people eat and drink as safely as possible. They work with you to identify the cause of your swallowing difficulties and recommend strategies that can reduce the risk of choking, aspiration and chest infections.
What is dysphagia?
Dysphagia is the medical term for difficulty swallowing.
It can affect:
- Eating food
- Drinking fluids
- Swallowing saliva
- Taking medication
Swallowing difficulties can occur for many reasons, including neurological conditions, stroke, ageing or other medical problems affecting the mouth, throat or oesophagus.
How can a Speech and Language Therapist help?
A Speech and Language Therapist will assess how well the muscles in your mouth and throat work together during swallowing.
Your assessment may include:
- Looking at the strength and movement of your mouth and throat muscles
- Watching you eat and drink different food and fluid consistencies
- Discussing any symptoms or concerns you have
Following the assessment, your therapist may recommend:
- Changes to food or drink textures
- Specific swallowing exercises
- Changes to your eating position
- Swallowing techniques to improve safety
If more information is needed, they may arrange further investigations such as a videofluoroscopy (a moving X-ray of your swallow).
If your swallowing difficulty appears to be caused by a problem lower down in the oesophagus, you may be referred to an Ear, Nose and Throat (ENT) specialist or Gastroenterology team for further assessment.
Tips for Safer Eating and Drinking
Small changes can make swallowing safer and more comfortable.
Before eating
- Sit as upright as possible.
- Make sure you are fully awake and alert.
- Ensure dentures fit well if you wear them.
While eating
- Take small mouthfuls and small sips.
- Eat and drink slowly.
- Reduce distractions such as television or radio.
- Avoid eating or drinking while lying down.
- Avoid using straws or spouted beakers unless specifically advised.
After eating
- Stay sitting upright for at least 30 minutes.
- If swallowing is difficult, avoid foods that are very dry, crumbly, chewy or hard unless your healthcare professional has advised they are safe.
Food Texture Modifications (IDDSI)
Some people benefit from eating foods with a modified texture to make swallowing easier.
Speech and Language Therapists use the International Dysphagia Diet Standardisation Initiative (IDDSI) to describe food textures consistently.
Common examples include:
Level 4 – Pureed
Smooth food with no lumps that requires no chewing.
Level 5 – Minced & Moist
Small, soft pieces that require minimal chewing.
Level 6 – Soft & Bite-Sized
Tender foods cut into bite-sized pieces that are easier to chew.
Your Speech and Language Therapist will explain which level is safest for you if a modified diet is recommended.
Thickened Drinks
Some people swallow drinks more safely when they are thicker.
You may be advised to:
- Drink naturally thick fluids such as smoothies.
- Use a prescribed thickening powder added to drinks.
Thickened drinks do not usually change the taste but alter the consistency to make swallowing safer.
If prescribed, it is important to follow the mixing instructions exactly.
Equipment That May Help
Specialist equipment can sometimes make eating and drinking easier and safer.
This may include:
- Specialist drinking cups
- Adapted cutlery
- Plate guards
- Special straws where appropriate
Your Speech and Language Therapist will advise whether any equipment would benefit you.
Swallowing Techniques and Positioning
Simple changes in posture can sometimes improve swallowing.
Depending on your assessment, your therapist may recommend techniques such as:
- Sitting in a specific position
- Taking two swallows for each mouthful
- Turning your head to one side while swallowing
- Chin tuck or head tilt techniques
These recommendations are individual to each person and should only be used if advised by your Speech and Language Therapist.
Looking After Your Mouth
Good oral hygiene is an important part of dysphagia management
Keeping your mouth clean helps reduce harmful bacteria and may lower the risk of chest infections.
Good oral care includes:
- Brushing your teeth or cleaning your mouth at least twice a day.
- Cleaning your mouth even if you have no natural teeth.
- Using a toothbrush and toothpaste whenever possible.
- Trying a low-foaming (SLS-free) toothpaste if ordinary toothpaste is difficult to manage.
- Cleaning your mouth more frequently if you experience a dry mouth, excess saliva or food residue.
- Using artificial saliva products if recommended by your Speech and Language Therapist or GP.
When Should I Seek Advice?
Speak to your healthcare professional if you:
- Frequently cough or choke when eating or drinking.
- Feel food is sticking in your throat.
- Notice your swallowing is becoming more difficult.
- Have repeated chest infections.
- Lose weight because eating has become difficult.
- Find eating or drinking stressful or tiring.
Early assessment can help identify the safest way to manage swallowing difficulties.
Further Information
If you have concerns about swallowing difficulties, speak to your healthcare professional or Speech and Language Therapist.
Neuro Rehabilitation Service
Telephone: 0300 125 5550
Email: sirona.neuro@nhs.net
Your Speech and Language Therapist can assess your swallowing, recommend strategies to improve safety, and advise whether further investigations or specialist referrals are needed.
