Safe swallowing depends on the coordination of many muscles in the face, mouth and throat.

The medical name for swallowing difficulty is dysphagia. Dysphagia can occur at any stage of life, from birth through old age. Swallowing may be impaired because of prematurity or developmental difficulty; stroke or neurological disease; respiratory illness like COPD or emphysema; cancer; head injury; surgery; injury to the face, mouth or neck; weakness or incoordination from other sources; and other reasons.

A person with dysphagia may have food and liquid enter the lungs instead of the stomach, which is called aspiration. A person may aspirate without being aware of any swallowing difficulty because of impaired sensation or thinking. If dysphagia is not treated effectively, a person may either develop aspiration pneumonia, which is a serious medical condition, or become choked on food lodged in the airway.

Possible signs of dysphagia include:

• Coughing, choking or strangling while eating, drinking or taking medicine.

• Wet voice quality or chest congestion after eating or drinking.

• Pneumonia, breathing difficulty, chest pain or rattling in the lungs.

• Spitting food out of the mouth or pushing the tongue out of the mouth.

• More trouble chewing or swallowing than usual.

• Food sticking in the mouth or throat after meals.

• Food coming back through the nose or mouth.

• Not being able to swallow saliva or drooling.

• Decreased intake of food or liquid; unexplained weight loss, malnutrition or dehydration.

• Becoming more tired or short of breath while eating.

• Taking a long time to finish a meal or giving up part way through.

When a person has signs of dysphagia, a physician may order an evaluation of swallowing ability. The medical professional who evaluates and treats dysphagia is a speech-language pathologist. A swallow evaluation may take place in an office or an X-ray department.

After being evaluated, dysphagia may be treated by strengthening muscles, compensating for weakness or changing the diet. Also, these simple guidelines may help make eating and drinking more safe:

• Be fully awake and alert before eating or drinking.

• Eat in a quiet, non-stressful environment with no distractions; turn off the television; do not hold a conversation while eating.

• Take your time; do not rush; chew thoroughly.

• Take small bites and sips.

• Sit straight up any time you eat or drink; never eat while lying down.

• Sit up for 20-30 minutes after eating.

• If you begin to cough or strangle, stop eating or drinking until the sensation has passed; do not take a sip of liquid.

• Brush your teeth and gums regularly.

There are times when a person cannot swallow any item safely or take in enough food or liquid to meet the body’s needs. If this happens, a physician may recommend an alternative feeding method, like a nasogastric or gastrostomy tube. These tubes bypass the normal swallow structures to provide food and liquid directly into the stomach. Even if one of these methods is used, a person may continue to work with the speech-language pathologist to improve swallowing abilities.

If you have signs of dysphagia, the first step to eating and drinking safely is to contact your physician and discuss your concerns.

Lisa Renfroe is a speech-language pathologist with Acute Rehabilitation at North Mississippi Medical Center.

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