Managing eating, drinking and swallowing difficulties  

This leaflet provides information for those caring for people with eating, drinking and swallowing difficulties.  This includes people in care homes, or those at home with carers or family support to eat and drink.  It will enable you to:

  • Identify individuals with potential swallowing difficulties
  • Identify which strategies to use to reduce risk to the person as soon as possible risk is identified (First Line Safer Swallow Strategies: FLiSSS)  
  • Know when and how to refer to Community Speech and Language Therapy (SLT) for further assessment.

What can be signs of swallowing difficulties?

  • Wet or 'gurgly' sounding voice/breathing, especially during or after eating or drinking   
  • Food, drink or saliva spilling from the mouth
  • A feeling of food sticking in the throat
  • Discomfort during eating/drinking
  • Multiple attempts to swallow
  • Food residue remaining in the mouth after eating
  • Holding food/drink in the mouth
  • Increased shortness of breath after eating/drinking
  • Coughing during or after eating/drinking
  • Choking (airway blocked by food) Recurrent chest infections
  • Unintentional weight loss, dehydration. 

What can you do to help?

Implement any of these First Line Safer Swallowing Strategies (FLiSSS) below, and refer to Speech and Language Therapy (SLT) if required.

As soon as swallowing difficulties are identified, the FLiSSS should be used to reduce risk and make the person more comfortable when eating and drinking. The strategies also will help with swallowing saliva and managing secretions.  

Successful use of FLiSSS may mean that a specialist assessment by a Speech & Language Therapist is not required.  If any concerns remain, refer to SLT for advice.  You are welcome to contact SLT to discuss at any time.  

For residents in care homes, staff must document any changes implemented as a result of the FLiSSS in the person's care plan. Discuss and agree the plan with the person, family and carers as appropriate. 

Implement 'first-line safe eating, drinking, swallowing strategies' BEFORE considering altering diet and fluid consistencies. Changes to fluid textures (thickening drinks) should not be made without referring to SALT. Thicker consistencies are not always safer. 
 

 

What are the First Line Safer Swallowing Strategies (FliSSS)?

Alertness
  • Only offer food and drink when the person is awake and alert
  • If the person is not sufficiently alert to eat and drink, contact the GP. 
Positioning
  • Make sure the person is sitting as upright as possible for eating/drinking.
  • Use cushions/pillows for support if needed
  • The head should be straight and level, not tipped back or looking up
  • The person helping should be sat down at the same level as the person being fed
  • To reduce reflux the person should remain semi-upright for at least 30 minutes after eating/drinking. 
Communication
  • Ensure hearing aids are in and glasses on
  • Tell the person what you are doing and make sure they can see the food if they are being assisted
  • Make sure the person is made to feel they are in control of what they eat and when e.g. 'Do you want the meat next or carrots?', 'Are you ready for the next bite?', 'This is porridge, is that ok for you?' 
Environment
  • Have meals in a quiet room, free from distractions (TV/radio off)
  • Talking while eating/drinking increases risk of coughing and choking - chat in between mouthfuls. 
Assistance
  • Encourage/assist the person to feed themselves if at all possible
  • Load the spoon for them and give it to them to eat with
  • Put the spoon in their hand and then assist them to lift it (hand over hand feeding)
  • Only feed the person if they are unable to do it themselves at all. 
Pacing and speed
  •  Eating and drinking safely may take a long time, so plan time for this
  • Control the pace so the person does not overfill their mouth
  • Swallow can be slow to trigger in some people
  • Ask them to swallow a second or third time if needed
  • A sip of drink might help some people to clear the food residue in their mouth/ throat
  • If food /drink goes cold, try using insulated cups/plates
Mouthful size
  •  Small sips/mouthfuls are generally safer than large
  • Try a smaller spoon for food e.g. teaspoon (not a large dessert spoon).
Equipment
  • For drinks, short, wide-brimmed open cups or cut-away cups mean someone can drink without tipping their head back
  • Try to avoid using lidded/spouted beakers, sports bottles, drinking straws.  Use normal, wide, open glass/cup as first option.  
Mouth holding behaviour
  • Meals are likely to take a long time
  • Make sure they have swallowed and cleared their mouth before giving any more
  • Look in the mouth before giving the next spoonful to check it is clear
  • Different / contrasting tastes and temperatures can help
  • Remind the person to chew/swallow (say 'swallow' or gently touch mouth/face).
Mouth care and teeth

Ensure the person has a clean, healthy mouth.  

  • Dentures (if worn) should fit well - softer foods may be easier for those who choose not to wear their dentures or who don't have many teeth
  • Check the mouth is clear of food residue at the end of the meal - particularly between the jaw and cheeks, and roof of the mouth
  • Mouth and teeth cleaning should be carried out at least twice a day. 
Saliva

The person needs to swallow their saliva safely too.  

  • Keep the person well positioned during the day and night to help this  
  • For some people it might be safer for saliva to drool out
  • Contact SLT if there are concerns about saliva management.   
Food
  • People may be able to eat more if offered small portions frequently throughout the day
  • Complete oral intake charts if concerned about reduced eating or weight loss
  • Food should look and smell appealing
  • Implement the above first-line safer swallowing strategies before considering altering food consistencies
  • Any changes to food textures must be discussed and agreed with the person or their next of kin and clearly documented in their management plan; this may not require a referral to Speech and Language Therapy unless signs of difficulty persist.   
Drinks
  • If the person coughs on drinks, implement all these strategies and refer to Speech and Language Therapy as required
  • Everyone who has thickened fluids must have an assessment by a Speech and Language Therapist. 
Medications
  • Discuss with the pharmacist or GP if the person has difficulty swallowing their medications, to find out if they can be given in easier to swallow forms
  • Do not crush tablets or open capsules unless advised to do so. 
 

 

How do I refer to Speech and Language Therapy about swallowing difficulties?

GP to complete the FCHC Adult SLT Referral Form and send via email to fchc.slt@nhs.net

For people at home, families and carers, contact your GP to request a referral to the local SLT team. For residents in care homes, staff to complete the Care Homes FCHC Adult SLT Referral Form and send via email to fchc.slt@nhs.net

 

 

First Community provides front-line NHS community healthcare services in east Surrey and parts of West Sussex.

We provide first-rate care, through our first-rate people, offering first-rate value. For more information visit: www.firstcommunityhealthcare.co.uk

If you would like this information in another format, for example large print or easy read, or if you need help communicating with us:

First Community (Head Office)

Call: 01737 775450 Email: fchc.enquiries@nhs.net Text: 07814 639034

Address: First Community Health and Care,  Consort House, 5-7 Queensway, Redhill, Surrey, RH1 1YB

For office use only: PFD_LTC046 First Line Safer Swallowing Strategies v1 Review Date June 2027