As promised, here are some guidelines that help safeguard against choking. We received these after my phone consultation with a speech therapist. If your loved one is having some difficulty at meal time, you may want to consider an evaluation by a speech therapist, the go-to profession for assessment of swallowing difficulties.
We have found these guidelines useful. Cold liquids generate a stronger swallowing response than warm liquids and you probably will want to follow every few bites of a meal with a swallow or two of cold liquid. You may even want to use small spoonfuls of crushed ice to clear the throat–we use Luigi’s Italian Ices, found at your local grocery–during the meal. We like the lemon and cherry–sometimes for dessert too! Frozen applesauce is good too. Your mileage may vary.
I hope these guidelines will be of some use to you. DISCLAIMER: Discuss these tips with a nurse or doctor prior to implementing; they may not be appropriate for everyone.
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Avoid foods that are difficult to chew, too dry or stringy, and foods containing both a solid and a thin liquid together (i.e. dry cereal with milk).
Take small bites and sips (one sip at a time with liquids).
Avoid using straws to drink as liquids are easier to control with cup sips.
Eat at a slow rate and use as many swallows as needed to clear each bite.
Encourage a chin down posture and upright positioning when eating or drinking.
Alternate solids with periodic sips of liquids throughout meal.
Use frozen applesauce, sherbet, sorbet, Italian ice or ice chips for thermal stimulation. Eat a few bites after each meal or periodically during meal if needed to clear residue.
Eat 5-6 times per day (three smaller meals plus snacks) for best nutrition and to avoid becoming too fatigued by trying to eat large meals.
Remain upright at least 45 min after meals to avoid reflux and to help manage secretions.
If voice sounds wet or “gurgly†encourage patient to clear throat and swallow again. If unable to clear throat on command, use a bite of frozen item to help clear.
If feeding patient sit at or below the level of the patient. This encourages the head down posture as patient does not have to look up at the caregiver.
If swallowing difficulties worsen request a speech therapy evaluation.