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  • Writer's picture Lauren Svensen FNP-C

What To Know About Trouble Swallowing

Many conditions can cause difficulty swallowing but for this article, I will focus on swallowing difficulties after a stroke, then give you some general tips to help a family member who has trouble swallowing.


Some people have trouble swallowing after having a stroke. Whether or not the stroke causes difficulty swallowing depends on what part of the brain was damaged during the stroke.

Some people who have a stroke neglect or forget about one side of their body. These people often have weakness on one side of their body and facial droop (only able to smile on one side of the mouth). When someone who had a stroke is eating, they often pocket food on the side of the mouth that they are neglecting which is the weak side of the mouth. This means they may finish a meal and have food left in their mouth they forgot to swallow. These people should eat in front of a mirror so they are more aware of the neglected side, and be verbally reminded to check the forgotten side of the mouth.

Having a stroke can cause difficulty swallowing foods properly which may cause food to go down the trachea (your windpipe) rather than the esophagus. A modified barium swallow is an imaging study that tells the clinician which foods are safe for the patient to eat. During the study different consistencies of food and liquid are mixed with contrast. If the study found that any food or liquid went down the trachea then a modified diet is typically ordered. Strict adherence to the modified diet order helps to prevent aspiration pneumonia which occurs when small pieces of food or liquid get into the lungs and start growing bacteria.

Sometimes a modified diet will require a thickening agent to be added to a liquid. The best way to do this is to follow the manufacturer's instructions exactly. Some thickening agents get much thicker as time passes never make a liquid thinner due to thickening over time. It is best to just discard the beverage and mix a new thickened liquid. There are several different consistencies of liquids that may be ordered, these are thin (like water), nectar, honey, and pudding thick.

Yes, pudding thick is the consistency of that chocolate pudding you love to eat.

General Tips for Safe Eating When Having Trouble Swallowing

  1. Anything yummy from the freezer that is liquid at room temperature may not be safe for someone who has a modified diet. Ice cream and popsicles are considered thin liquids (like water) and are not safe for anyone who needs thickener added to their liquids.

  2. If someone needs thickened liquids then ice is not safe to add to the beverage. As the ice melts the beverage will become thinner than when you first mixed it.

  3. In my experience dry powdered thickener causes the beverage to get thicker over time, think 30 minutes to an hour. On the other hand, liquid thickener does not appear to have that same effect. Both types of thickeners are appropriate to use, be sure to follow the mixing instructions exactly.

  4. Many people on a modified diet have trouble swallowing safely using a straw. Be safe and avoid straws unless your healthcare provider says it’s okay.

  5. It is best to eat sitting upright at 90 degrees if you have trouble swallowing and to stay sitting upright after the meal.

  6. If you are helping feed a family member who has trouble swallowing offer small bites of food and alternate food with small sips of liquids. Understand this may take significantly more time than it may take you to eat. This is not a speed-eating competition!

  7. Some people may need to crush their pills to swallow them safely. Extended-release medications are not safe to crush so be sure to communicate with your clinician before doing so. One helpful tip for taking pills whole is to take it with a bite of applesauce, yogurt, or pudding.

  8. If a family member frequently coughs after eating or drinking, be sure to tell their healthcare provider. Coughing while eating may be a sign the food or drink is going down the windpipe.

  9. Tucking your chin down will also help with swallowing. Many people want to throw their heads back when swallowing pills, but this does not help.

*This article is intended for general information purposes only and is not medical advice. Please seek counseling from your primary care provider for personalized medical advice.


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