Nutrition: Practical Swallowing Tips
A resource, we found helpful and that we highly recommend is a booklet called Meals published by the MDA. Visit their website for more information about obtaining this helpful resource. http://www.mdausa.org/publications//meals. Each person is unique and what works for one, does not help another. A Speech Therapist (which your doctor can refer you to) can test your swallowing skills. The risk of choking and aspiration increases when swallowing muscles weaken. A therapist will make specific and individualized recommendations about specific swallowing and positioning techniques and recommendations about the types of foods that should help prevent choking and aspiration. Below are some recommended techniques that are used by individuals with weakened swallowing muscles to achieve a more successful swallow. These recommendations are appropriate for individuals with or without choking issues.

1. Environment - When eating, concentrate on swallowing and eating. Avoid speaking when eating. Never hurry! Take one bite at a time. Ask members of your family not to talk to you while you are eating. You might want to start eating before the rest of the family and then share in the social time and conversation when you are done and they are eating. Most choking occurs when you are distracted or trying to talk and eat when you are tired. Another helpful recommendation is to eat smaller meals more frequently during the days (5 small meals instead of 3 large meals).
2. Head Positioning - Keep your head level or tilted slightly forward to avoid exposing your airway to food. Keep your chin down while swallowing.
3. Trunk Positioning - Keep your trunk at 90 degrees when possible, whenever drinking liquids. Never eat or drink when reclining.
4. Lip Seal - Keep your lips tightly closed after inserting food or liquids. A caregiver can help with this by placing his/her forefinger on your top lip, middle finger under your lower lip and thumb up in front of your ear. While their hand is in this position, it will help you with lip closure.
5. Jaw Position - Close your lips and teeth as tightly as you can as soon as the food is inserted into your mouth before you begin to chew and swallow.
6. Swallow Often - Smaller bite sizes are handled easier. Sometimes a double swallow after each bite is easier.
7. Tongue - If your tongue movement is difficult, avoid placing food on the tip of your tongue. Place food in the mid to back area of the tongue. Do not DROP the food on the back of the tongue, as this will cause a "gag" reflex. Firmly run the spoon from the front to the back of the tongue in a slow motion or movement. Some people do not tolerate food at the back of their tongue, so may do better with food placed in the middle part of the tongue.
8. Cough or Clear the Throat After Each Swallow - this will help clear your airway and avoid aspirating.
9. Hold Your Breath - When you hold your breath during a swallow, this will close the vocal cords and will keep food out of the trachea or airway. Do not breathe in when you are in mid-swallow. Try to complete your chewing and swallowing before you take a breath. Remember to keep your chin down while swallowing.
10. Dry Throat or Phlegm - A dry throat or sticky phlegm can make it hard to swallow food. To avoid this, try taking a small spoonful of liquid of tolerated consistency before each bite.
11. Food Consistencies - The best food consistency for you will depend of your ability to chew, to maneuver the food in your mouth, and on your swallowing ability. The speech therapist can recommend foods you should avoid and what foods will most likely be consumed with the most ease.
    • Change eating choices to foods that are easier to swallow - smooth one-texture or semi-solid foods similar to commercially prepared baby food or foods like yogurt, cream soups, mashed potatoes, pasta, milkshakes, and hot cereal. Many foods can be pureed (put in the blender at home) to achieve the semi-solid consistency. Avoid dry foods that tend to stick (cornbread, rice, coconut) and multi-textured foods like dry cereal in milk or meat/vegetables in thin soup. The first time I started gagging was on a piece of coconut. My wife had made a coconut cream pie for my birthday and the first bite, my swallowing had become so weak that I could not swallow hard enough to get a little piece down that had been stuck in the back of my throat. (That was the first time we had to use the suction machine- she put the yankaur down my throat and in her "calm" …(panic), she about gave me a tonsillectomy…
    • We were never quit sure, if she ever got that piece of coconut!) You have to keep your sense of humor in this journey!
    • Add nutritional supplements like Promote, Boost, Carnation Instant Breakfast, Scandishake- add ice cream and make a milkshake.
    • Unless directed otherwise by your doctor - add high calorie foods, fats (i.e. whole milk not skim).
12. Large pills and other medications and vitamins are difficult to swallow. Ask your pharmacist to help you find chewable or liquid forms of your medications or vitamins. Or ask him or her if the medication can be crushed or dissolved. In addition, your doctor can help with this.
13. Ask you doctor for a prescription for a suction machine and instructions on how to use it.
14. Thickened Liquids - It is easier to swallow thickened liquids and easier to choke and/or aspirate on thin liquids. If you find you are choking on thin liquids, such as water, thicken your liquids with a thickener.