Tips for Managing Dysphagia at Home During the Holidays

Safer Swallowing Strategies

Continue the safer swallowing strategies that your therapist (speech-language pathologist/SLP) recommended, and don’t forget some of the basics that may be overlooked in a busy holiday setting.

General Strategies

• Eat slowly enough to chew and swallow one bite before putting in the next bite.
  Do not talk with food in your mouth. Make sure to chew, swallow, and perform any additional swallowing strategies before talking.
• Make sure you are in a good sitting position with any supports as needed.
• Self-feeding is safer than dependently being fed by someone else. If you have someone helping you, they could provide the necessary assistance to help you feed yourself as much as possible.
• Make sure your mouth is clean and moist prior to eating. If you have dry mouth, bring your artificial saliva substitute spray bottle with your. Spray, swish and swallow before your meal to literally lubricate your swallowing pipes to better enjoy your meal!

Customized Strategies

• Your speech-language pathologist (SLP) who specializes in swallowing may have recommended customized strategies based on your comprehensive swallowing evaluation*. For example, some people are provided with the strategy to alternate bites of foods with sips of liquid. Make sure to have liquids handy with your meal to help you manage any food residue buildup in your mouth, throat or food tube (esophagus). Some people like to have a moist puree (like applesauce or cranberry sauce) to push down a drier food that feels stuck in the throat or food tube.

Foods

Enjoy many naturally-pureed foods around the holidays

• Many foods, like squash, mashed potatoes, and smooth cranberry sauce, are already prepared pureed. Pumpkin pie, with a very moist and crumbled graham cracker crust, is also quite easy to swallow.

Add moisture to make foods slippery

• Adding gravies and sauces to purees and other soft foods gives a delicious flavor punch, while making them moist and slippery for easier swallowing.
• As foods cool down, they will tend to become stickier. Watch out for mashed potatoes, as they can be quite a thick and sticky puree. Add butter, gravy, and sour cream.
• Heart healthier option: delicious olive oils (i.e., some come with flavors of basil, rosemary, thyme, or other spices to compliment foods). Many people with dysphagia find that olive oil really does the trick to make foods more slippery and prevent them getting stuck.

Soft, moist, and cut-up foods help reduce the risk for choking, per IDDSI.org (International Dysphagia Diet Standardisation Initiative)

• When you cut meats and vegetables up to a 1.5cm size bite (which is about the size of the adult person’s thumbnail), then there is less risk for the bite of food to block the airway (choking).
• This bite-size is 8mm for children (or the size of the child’s pinky nail).
• Test if foods are really “soft” with IDDSI’s Fork Pressure Test. Simply press the fork into a piece of food with your thumb pressing into the bowl of the fork. You will see your thumbnail turn white with the appropriate amount of pressure. The food should squash and leave fork marks, not returning to its original shape.
• The food will be moist enough if the piece of food also does not stick to the fork with your Fork Pressure Test.

Thickened Liquids

Bring portable-convenient thickener packets or thickeners in a zip lock bag or sealable tupperware

• Additionally, bring your own teaspoon or tablespoon measuring device for adding your thickener without having to ask your host. Being prepared ahead of time helps you be discrete and focus on the fun of the holidays rather than all the technical needs of your difficulty with liquids.

Bring own liquids in screw-top or resealable bottles

• Resealable bottles will allow you to prepare your liquids ahead of time or add thickener packets to any liquid just before serving. Just shake and stir in your bottle and pour your beverage into that nice glass on the table. That makes it easy for family members to meet your thickened liquid needs.

Check out all soups and other liquids to make sure they are the appropriate thickness

• That Eggnog will likely pass an IDDSI Flow Test (link to IDDSI Flow Test) as a Mildly Thick Liquid, Level 2 (aka, old term of nectar thick liquid). If your host is serving a soup that has solids in a clear-thin liquid broth, that is a mixed consistency, and it may be harder to manage for a person with dysphagia. Soups can be easily blended to a smooth and thick consistency by using a portable blender (e.g., Magic Bullet). Potatoes will naturally thicken a soup when blended, or you may have to add a little thickening agent to your final product to meet your prescribed thickened liquid level.

Environment

For many people challenged by dysphagia, swallowing difficulties are accompanied by other difficulties that can impact your social setting: hearing loss, impaired vision, difficulty attending with background noise, and reduced cognition, memory, and safety-awareness (such as in people with dementia or Alzheimer’s Disease). Often the host can maximize the abilities of their guest by tweaking the environment to make for a better holiday experience.

Reduce distractions

• Make sure to turn off TV or lower the volume on background music when the family is having conversations around the dinner table or elsewhere.
• Reduce the amount of food and drink items that are in front of the person who has difficulty with distractions. One plate, one utensil, and one cup may be enough. Who really needs three forks anyway!
• Think about seating arrangement around the table, placing one or two people next to the individual that could provide subtle help and cues as needed.
• Watch out for trip hazards as your loved one moves around your house, especially if they require a walker or cane. Thresholds between rooms and throw rugs are common areas that may cause trips and falls. Toys on the floor also will become distractions and trip hazards. Ask yourself, is there an easy pathway to the bathroom?

Lighting and Visuals

• Make sure to have good lighting in your dining area.
• Use plates that provide a good visual contrast between the plate and the food.

Sensitivity

The fact that holidays are all about food is really challenging for someone with dysphagia, especially if your loved one is not able to eat by mouth or has a very limited diet.

• As your family gathers, consider de-emphasizing the food.
• Your main gathering room could have less trays of foods, and emphasize other activities: music, dancing, games, decorations, and candles with non-food related aromas or unscented.

Humidification

Yes, it is wintertime, and many houses are very dry with the heat blasting.

• Try adding humidifiers, as your loved one with dysphagia and dry mouth will really appreciate it.