How can I help myself?

It is important to continue eating normally as long as it is safe to do so. This will help to keep muscles working and, of course, maintaining a healthy diet will help ensure good health (see Diet & Nutrition ). Only when eating and swallowing become significantly uncomfortable or difficult should your diet be adapted, for example pureeing foods. There are many ways you can help make swallowing easier and minimise the risk of aspiration, which is food entering the lungs. However, difficulties in eating are individual and solutions vary from person to person. But the following tips may be helpful:

• Moist and soft foods are easier to eat, e.g. custards, jelly, pureed fruit, yoghurt, ice cream, omelette, well cooked meats moistened with sauces or casseroles, soup, short pastas, mashed vegetables, banana
• Avoid dry, brittle foods, such as toast or crackers, or if you really like to eat these moisten them with plenty of spread or dip them in something like soup
• Eat wholemeal bread rather than white as it is less likely to get stuck around your mouth
• Instead of bread try pasta, noodles or mashed potato as carbohydrate in a meal
• Avoid soups with bits in such as minestrone and go for thick creamy ones rather than thin, watery soups
• Food with a good flavour and smell tend to be easier to swallow as they stimulate saliva production
• Thick drinks such as milk shakes and smoothies which move more slowly may be easier to control and swallow than thin drinks. Thickeners can be added to thin drinks to reduce the likelihood of choking
• Eat smaller portions but have more meals and frequent snacks
• Use a teaspoon rather than dessert spoon to encourage small mouthfuls
• Relax and enjoy your meal. If you are relaxed your throat is more likely to be also and swallowing will be easier
• Drink sips of water whilst eating and take a break between mouthfuls so that you can empty your mouth fully
• Try to keep your meals well presented – if they look and smell appetising you are more likely to want to eat and to enjoy your meal
• Relax the throat muscles by yawning before and during eating
• Make sure that you are comfortable and sit up straight without leaning on the table
• Sit upright for 10 minutes before eating, whilst eating and for 30 minutes after. Good posture is important in making eating and swallowing as easy as possible
• Try tucking your chin down to your chest to make swallowing easier
• Do not tilt the head back when eating as this makes swallowing more difficult
• Try not to eat meals when you are ‘off’ as eating will be much more difficult and choking more likely
• Do not eat foods that you have been advised to avoid. If your diet has been modified, stick to the recommended foods and consistencies
• Keep distractions to a minimum during mealtimes – turn off the television
• Do not talk with food in your mouth
• Take regular sips of water but only when a mouthful, or most of it, has been swallowed
• Only take more food when the mouth has been cleared of the previous mouthful
• Double swallow if food did not all go down first time
• Ensure that any dentures are a good fit and not uncomfortable when chewing
• Brush your teeth at least 3 times a day, checking for any food that remains in the sides of the mouth
• Involve the family – make sure they are aware of the problems you experience and the need to allow you to take your time
• Time medications to allow optimal swallow function at mealtimes.
• Avoiding the following foods will also make eating easier:
• • Dry, crumbly or hard foods which are harder to swallow and the risk of choking is higher
• Mixed consistencies, that is solid and liquid together, such as some soups, which are harder to cope with
• Milk products and other foods that increase mucous levels
• Food which sticks to the roof of the mouth or gets caught around the mouth, such as tomato with the skin on, biscuits, bran flakes and hard-boiled eggs
• ‘Sticky’ foods such as white bread and mashed potato
• Nuts, grains and seeds
• Tough, fibrous fruit and vegetables.

A semi-solid diet will make swallowing much easier. In extreme difficulty a puree diet may be appropriate, but you should only follow such a diet on the advice of your doctor, dietician or speech and language therapist. It is important that energy intake is maintained and when liquid meals are introduced a dietician may recommend special drinks formulated to supplement your diet and provide essential nutrients.

Dental hygiene and care is still important even when alternative feeding methods are used. Teeth should still be brushed at least three times a day and a mouth rinse may also be used to avoid a build up of plaque and poor breath. If oral care is not maintained, oral infections are more likely and these increase the risk of chest infections.

 

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