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Caregiver Solutions: Managing Swallowing Problems

People take the act of swallowing for granted, but it is actually a very complex mechanism that starts when you first see food, triggering the salivary glands to start secreting saliva. Swallowing is usually an involuntary process during eating, a reflex activated when food touches the soft palate at the back of the mouth.

Swallowing Problems: Probable Causes

Many swallowing problems are caused by lack of saliva or a dry mouth. There are many reasons the salivary glands may not be producing enough saliva:

  • Over 400 medicines can reduce the quantity of saliva or alter its chemical composition so that it does not work properly. These medicines include those for depression, hypertension, urinary incontinence and allergies.
  • Diabetes and Parkinson’s disease can cause dry mouth; Parkinson’s can also weaken the muscles involved in the chewing and swallowing functions. Sjögren’s syndrome, an autoimmune disease, acting by itself or in tandem with rheumatoid arthritis or other autoimmune diseases, can also impede saliva secretions.
  • Cancer treatments, such as radiation therapy targeting the head and neck, can impede or even altogether stop the production of saliva. Chemotherapy can lead to thicker saliva, which gives a sticky or dry sensation in the mouth.
  • Head or neck injury can impair nerves controlling the salivary glands.

Swallowing Problems: Tips to Make Eating Easier

When a loved one is experiencing swallowing problems, your challenge is to find ways to make their foods easier to take in. Here are some simple diet modifications that can help.

  • Select moist foods. These are softer and easier to swallow. For breakfast, oatmeal is preferable to dry cereal. For lunch, try soup or broth and soft fish like tuna or egg salad. For dinner, a soft, noodle-based casserole is a soft choice. Fresh or canned fruits, such as peaches and oranges, have plenty of moisture.
  • Avoid foods that crumble. Crackers, for instance, might cause some gagging. If only dry foods are available, moisten them in non-spicy sauces.
  • Avoid rough grains and other particulate foods. Rice and other grains may cause choking. Look for softer substitutes for the nutrients needed, like mashed potatoes as a starch.
  • Stay away from spicy foods and salty dishes. They absorb more water and make the mouth drier. Spicy foods also irritate soft mouth tissues.
  • Steam raw vegetables thoroughly. Eating them raw will be difficult, but steaming them until they get soft will make them easier to eat and preserve their nutrients. To add flavor to steamed vegetables, top with a simple pasta sauce.
  • Pick soft foods for dessert. Try flavored gelatin or a smoothie with a yogurt base. Cookies are fine if you soften them by dipping in liquids such as milk or tea.
  • For very dry mouths, puree or “blenderize” food. This breaks down the food into a smooth consistency and makes it easier to swallow. Through a little trial and error, you’ll need to uncover whether the patient finds it easier to swallow thicker or thinner liquids.
  • Between meals, offer gum or candies (both sugar-free) to keep the mouth moist. This may help induce the glands to produce saliva.
  • Help your loved one consume between 6 and 8 cups of fluids each day. Swallowing problems can lead to a reduced ability to detect thirst, which means they are likely to forget drinking water. Dehydration can also lead to reduced saliva secretions.

Swallowing Problems: Food Preparation Pointers

  • Puréed foods are perfect for people having great swallowing difficulties. Puréeing means reducing food to smooth consistency, like mashed potatoes; meat should have a pasty consistency. A thickening agent can help these foods maintain their shape. Popular thickening additives on the market are Thick-It Instant Food Thickener Powder by Milani Foods, Thick n Easy by American Institutional Products and Thick Set and Thixx, both made by Bernard Fine Foods. Thick-It also has a line of pureed foods, from breakfast choices through dessert.
  • For people whose swallowing problems are not too severe, mincing or chopping foods may be enough. Mince the foods in pieces as small as sesame seeds, about 1/8 inch.
  • As swallowing ability improves, the caregiver can start giving ground or diced food, about 1/4 inch in size, or about as big as a grain of rice.
  • Eventually chopped foods about 1/2 inch in size can be tried, about the size of bread cubes.
  • People with minor swallowing problems can be fed normal-sized food, but modified in texture to a soft and moist consistency.

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