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Caregiving advice: How to feed someone with a swallowing difficulty

Assorted MilkshakesWe like to break bread with others, and we like to think a person who is eating is on the road to recovery. But when a loved one has trouble swallowing, “we don‘t realize how dangerous food can be,” says speech therapist Kim Brown of Upstate University Hospital.

Choking is an obvious hazard. Aspiration pneumonia develops more subtly, after food particles or liquids slip down the windpipe and infect the lungs. Getting adequate nutrition into a person who struggles to swallow can be a challenge, even for professional caregivers.  Brown, along with speech language pathologist Jenna Gardner and clinical dietitian Traci Hourigan have picked up a few tricks in their careers. Here are their strategies for keeping mealtime safe, and palatable:

  • Focus on eating, without the distraction of television or side conversation. Host separate social gatherings that aren‘t centered around mealtime.

  • Take advantage of the times of day you are hungriest, and make that the biggest meal.

  • Be deliberate with each bite. Maybe serve a single food at a time.

  • Eating smaller meals more frequently may help get in adequate calories, if big meals tire your loved one. Drink fluids (including soups and shakes) throughout the day.

  • Increase calories by adding cream, butter, sour cream or milk to recipes, and jellies or honey to sweeten foods.

  • To increase protein intake, use milk instead of water in recipes and add powdered milk to cereals, puddings and mashed potatoes. Make smoothies with yogurt, milk and peanut butters. Add eggs to casseroles. Grate cheese on favorite foods.

  • Avoid feeding someone in bed. Sitting the person upright in a chair can help direct food away from the airway.

  • Coach your loved one to put a bite of food in his or her mouth, then lower chin to chest before they swallow. This may seem awkward, but it helps block the airway so food goes down the esophagus to the stomach.

  • In cases of dementia, swallowing difficulty is often a matter of cognition, of forgetting to swallow, so this can be coached, too.

  • For some people with facial weakness or oral cancers, straws are a necessity – although Brown is not a fan of straws, since using them makes it difficult to know how much liquid a patient takes in.

  • Recognize that taste buds may be compromised in some diseases, leaving food unappealing. Someone who suffers a brain injury, for instance, may dislike foods he or she used to crave.

  • Some diseases leave people unable to smell food, while other diseases may prompt a heightened sense of smell. Just be aware of this.

  • If you are pureeing food, Brown acknowledges that “it‘s a big challenge to make it look presentable and make it taste good.” But it can be done. She says to soften foods with milk. To thicken foods, use a cornstarch-based product such as Thick-It, or pureed mashed potatoes.

  • Thicken beverages with avocado, which adds healthy fats without changing flavors.

  • Enliven pureed foods with hot sauce, herbs or spices. Blend with your loved one‘s taste in mind.

  • Restaurants can be tricky, but they are not necessarily off limits. Gardner knows patients who bring portable blenders out to eat. Others disassemble foods from the menu, breaking apart a hamburger, for instance, into edible chunks.

  • Some people on pureed diets don‘t mind the taste of jar baby food. Preserve your loved one‘s dignity by serving the food on tableware rather than from the jar.

  • The thinnest liquids (water, broth) can cause the most problems, particularly for people with a loss of sensation, which can happen after a stroke. Since they can‘t feel where the liquid is going, they are at risk of aspirating.

  • Be extra careful when feeding foods of mixed consistency, including chicken noodle soup, which blends broth and noodles and vegetables, and dry cereal, which blends milk with crunchy morsels. Breads are another treacherous food since they can crumble apart when eaten.

  • Oral care after meals is an important step in preventing aspiration. Help your loved one brush their teeth, or at least inspect his or her mouth after eating to remove any leftovers.

  • Keep a food journal, noting what and how much your loved one ate at each meal. This will help track nutrition and pinpoint any problem foods. And monitor weight weekly so you can alert health providers of changes.

Find this and additional stories in the winter issue of Upstate Health.