Dysphagia at the Holiday Dinner Table

Dysphagia

Nov 20

Thanksgiving through the New Year, a 5 week period where the holiday celebrations are in full swing. While rituals vary from person to person, by religion and culture, one practice seems to be universal- sharing a meal.

Whether it be grazing appetizers or a sit-down dinner, eating is viewed as a social practice that increases bonding, feelings of wellbeing, and enhances one’s sense of contentedness and embedding within the community.

But imagine this holiday season is a little different. This year, you cannot have your beloved Christmas cutouts and hot chocolate. Instead, your dessert option is pudding, and thickener has to be added to your favorite drink.

WELCOME TO THE REALITY OF SOMEONE WHO IS EXPERIENCING DYSPHAGIA.

What is Dysphagia?

Dysphagia, commonly known as “difficulty or discomfort in swallowing” occurs as a result of various medical conditions such as cancer, dementia, Parkinson’s disease, multiple sclerosis, muscular dystrophy, and stroke, brain or spinal cord injury. Additionally, dysphagia can be a post-operative complaint following procedures such as anterior cervical spine surgery (ACSS), or due to post-extubation trauma.

Dysphagia is not “cookie-cutter.” Each individual experiences different symptoms ranging in severity and duration. Common characteristics of dysphagia include:

coughing during or right after meals
food or liquid remaining in the mouth after meals
poor lip closure
food or liquid spilling from the mouth
frequent drooling
complaints of food "sticking"
globus sensation—complaints of a "fullness" in the neck
complaints of pain when swallowing
wet or 'gurgly' sounding voice during or after meals
difficulty coordinating breathing and swallowing
recurrent pneumonia; extra effort/time needed to chew
and changes in eating habits—specifically, avoidance of certain foods/drinks.

Altered diets

Due to the risk of discomfort while swallowing, choking and/or aspiration, an altered diet may be recommended to increase safety, efficiency, and ease of swallowing. Dysphagia diets make it easier to chew and move food in the mouth and reduce the risk of food or liquid going into the trachea (aka “windpipe”), which leads to the lungs. The following explains each diet in further detail.

NATIONAL DYSPHAGIA DIET (NDD)

NDD diet levels are common terms to be familiar with as they may be the levels recommended by your local hospital, nursing home, or SLP.

Regular diet: all foods are permitted.
Mechanical Soft diet: recommends foods that are moist and tender, easy to chew, and breakable with a fork. This diet may be recommended for someone experiencing difficulty chewing, moving food around the mouth, and at risk for solids getting stuck in the mouth or throat. Examples of permitted foods include breads, rice, cooked tender vegetables, pasta, rice, eggs, casseroles, soft fruits, and tender meats. Foods that are typically restricted include dry bread, crackers, raw vegetables, fruits with skin, nuts, dried fruit, and tough/dry meats.
Puree diet: often recommended for individuals with moderate-severe dysphagia. Food should be of a mashed-potato consistency, not too runny or liquidy. A blender or food processor is used to achieve proper consistency. Permitted foods include pureed breads, smooth puddings, custards, yogurts, and pureed desserts, pureed fruits and well-mashed bananas, pureed meats, well-moistened mashed potatoes, pureed soups, pureed vegetables without lumps, chunks, or seeds.

INTERNATIONAL DYSPHAGIA DIET STANDARDIZATION INITIATIVE (IDDSI)

IDDSI is a new initiative to standardize altered diets across the world - although this is rather new, it is suspected to become more mainstream in the coming years. Your local hospital, nursing home, or SLP may refer to these diet levels.

Regular/Easy to Chew: Normal everyday foods of various textures that are developmentally and age-appropriate. Biting and chewing ability needed.
Soft & Bite-Sized: Tender and moist throughout, with no thin liquid leaking or dripping from the food. Chewing ability needed.
Minced & Moist: Ver soft, small moist lumps, minimal chewing ability needed.
Pureed: Smooth with no lumps, not sticking, no chewing ability needed.

For further detail and food/liquid testing visit iddsi.org.

Thickened liquids

Just as there are various altered diets to meet the needs of individuals experiencing dysphagia, thickened liquids are also designed to reduce the risk of aspiration. Thicker liquids travel slower down the throat which gives the body more time to control and direct the fluid down the esophagus and into the stomach.

Thin liquids (Level 0 - Thin): also known as regular liquids, do not restrict beverages of any consistency.
Nectar thick liquids (Level 2 - Mildly thick): Liquids that have been thickened to a consistency that coats and drips off a spoon, similar to unset gelatin.
Honey thick liquids (Level 3- Moderately thick): Liquids that have been thickened to a honey consistency. The liquid flows off a spoon in a ribbon, just like actual honey

There are various brands of liquid thickeners on the market. Examples include SimplyThick, Thick It, and Thick and Easy. Thickeners can be purchased at drug/medical stores, and can come in powder, gel or pre-packaged form.

Importance in following altered diets

Now that you have a better idea of what an altered diet may consist of, it is crucial to follow the recommendations made by you or your family member’s speech-language pathologist (SLP). The SLP is the one who assesses swallowing function either at the bedside or through imaging, and makes recommendations based on one’s anatomical functioning and/or presence of clinical signs and symptoms of aspiration. Following their recommendations can reduce the risk of pain when swallowing, choking, and aspiration which can lead to pneumonia.

Accommodating an altered diet

Being on an altered diet can be difficult to get used to, let alone during the holidays. Fortunately, there is a way to make the transition easier which will make one more comfortable at the table. Being on an altered diet does not mean all of your, or your loved one’s favorite holiday foods have to be restricted. Instead, depending on the recommended diet, you may be able to add gravies or sauces to meet their needs. In addition, there are various foods that occur naturally in altered form; for example, apple sauce and mashed potatoes are considered puree solids that do not require any further preparation. If you are concerned about meal preparations that need to accommodate an altered diet, it is strongly recommended that you speak with your SLP to discuss permitted options and ways to incorporate naturally occurring consistencies into your meal.

This holiday season, as you give thanks, take a moment to be grateful for the skill we take for granted on a daily basis- being able to eat. Unfortunately, we typically do not recognize how lucky we are to be able to eat without restriction until we can’t anymore. If this is the case for you or your loved one, we strongly recommend that you schedule a consultation with a speech-language pathologist who can diagnose, treat and help to restore your swallowing function so that you can enjoy your beloved holiday treats next year.

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ABOUT THE AUTHOR

Allison Walsh, MS, CCC-SLP

Allison is a speech-language pathologist based in Buffalo, NY. Her clinical interests lie in communication related to Parkinson’s disease and dysphagia treatment. Allison is the volunteer coordinator for The Parkinson’s Foundation, Buffalo chapter.