Swallowing Disorder - Feeding Difficulty

About Swallowing Disorders

Think about how you eat. You first have to get the food or drink to your mouth. You may use a fork, spoon, straw, or your hands. You have to open your mouth and take the food in. You close your lips to keep the food in your mouth. You then chew the food or move the liquid to get ready to swallow.

We all have problems swallowing sometimes. We may have trouble chewing a tough piece of meat. We may gag on food or have to swallow hard to get it down. And we have all had a drink “go down the wrong way,” making us cough and choke. A person with a swallowing disorder will have trouble like this all the time. A swallowing disorder is also called dysphagia (dis-FAY-juh).

Swallowing happens in three stages, or phases. You can have a problem in one or more of these phases. They include:

  • Oral phase – sucking, chewing, and moving food or liquid into the throat.
  • Pharyngeal phase – starting the swallow and squeezing food down the throat. You need to close off your airway to keep food or liquid out. Food going into the airway can cause coughing and choking.
  • Esophageal phase – opening and closing the esophagus or the tube that goes from the mouth to the stomach. The esophagus squeezes food down to the stomach. Food can get stuck in the esophagus. Or, you may throw up a lot if there is a problem with your esophagus.

Signs of Swallowing Disorders

General signs of a swallowing problem may include:

  • coughing during or right after eating or drinking
  • wet or gurgly sounding voice during or after eating or drinking
  • extra effort or time needed to chew or swallow
  • food or liquid leaking from your mouth
  • food getting stuck in your mouth
  • having a hard time breathing after meals
  • losing weight

As a result, you may have:

  • dehydration or poor nutrition
  • food or liquid going into the airway, called aspiration
  • pneumonia or other lung infections

You may feel embarrassed when eating. You may feel badly about your swallowing problems and want to eat alone.

Causes of Swallowing Disorders

There are many conditions that can cause swallowing problems. Some medications can cause dry mouth, which makes it hard to chew and swallow. Other causes include the following:

Damage to your brain or nerves from:

  • stroke
  • brain injury
  • spinal cord injury
  • Parkinson's disease
  • multiple sclerosis
  • amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease)
  • muscular dystrophy
  • cerebral palsy
  • Alzheimer's disease

Testing for Swallowing Disorders

An SLP can test you to see how you eat and drink. You want to see an SLP who works with adults with swallowing problems. The SLP will

  • ask you about your health, past illnesses, surgeries, and your swallowing problems
  • see how well your mouth muscles move
  • watch you eat to see how you sit and feed yourself and what happens when you swallow
  • do special tests, if needed. The SLP can watch how you swallow using:
    • modified barium swallow – you eat or drink food or liquid with barium in it. Barium shows up on an x-ray so the SLP can watch where the food goes.
    • endoscopic assessment – the doctor or SLP puts a tube with a light on the end in your nose. This scope has a camera on it, and the SLP can watch you swallow on a screen.

Treatments for Swallowing Disorders

What treatment you need will depend on the problems you have. You may need medical treatment, such as medicines for reflux. In severe cases, you may need to get nutrition in other ways. These may include a tube through your nose or in your stomach. Your doctor will work with you if you need tube feeding.

The SLP can work with you to improve how you swallow. The SLP may suggest:

  • treatment to help you use your muscles to chew and swallow
  • ways you should sit or hold your head when you eat
  • strategies to make your swallow better and safer
  • eating softer foods or thicker drinks to help you swallow

Your family or caregivers can help you by:

  • asking questions to understand the problems you have
  • making sure they understand what the SLP will work on
  • following the suggestions your SLP makes
  • helping you with exercises
  • making food and drinks that you can swallow safely
  • keeping track of how much you eat and drink
Reference: http://www.asha.org/public/speech/swallowing/