1. The patient must be in an upright, sitting position so that gravity can assist the swallowing process. Keep patient upright for at least 15 to 20 minutes after a meal to reduce the chances of gastric reflux.

  2. Feed patient slowly, starting with half bites to reduce anxiety and likelihood of choking. Make sure they have swallowed completely before giving them another bite. Allow for pauses throughout the meal if the patient takes a long time to eat to prevent over-tiring.

  3. If the patient stops eating, a light touch on the chin can help bring attention and focus back.

  4. To aid in triggering the swallowing reflex, place the spoon on the tongue and press down gently.

  5. Don’t try to wash food down with liquids as this increases aspiration risk. Instead, offer a small sip between bites, preferably with a sippy cup.

  6. If there is risk of aspiration, thicken liquids to nectar or honey thickness with ThickIt or other commercial thickener. *

  7. The environment should be very peaceful and relaxed to reduce distractions and allow for full concentration.

  8. Avoid foods that crumble, are hard, crisp, sticky, chewy or crunchy. If the patient eats very slowly and is an aspiration risk; ice cream, jello or anything liquid at room temperature must be avoided.

  9. Try different positions such as the head tilted to the stronger side when chewing and swallowing, forward with chin down for each swallow, or any other position that helps with your particular patient.

  10. Instruct the patient to eat in a very deliberate fashion: chew each bite thoroughly, pause, concentrate on swallowing and then swallow.

  11. If the patient complains of dry mouth, moving the tongue in a circular fashion against the insides of the cheeks can help stimulate salivation.

  12. Avoid eating less than three hours before bedtime to reduce the likelihood of food getting caught partway down and staying there overnight.

  13. Serve five to six small meals a day instead of three large ones.

  14. Emphasize soft, moist foods. Diet progresses to puree as swallowing difficulty worsens.

  15. Check the patient’s mouth after meals and clear out any remaining food particles.

* Haven Hospice will provide ThickIt to patients for whom a consult has been completed by the dietitian.