What dietary modifications or swallowing techniques can I recommend to patients experiencing dysphagia?

Dietary modifications for patients with dysphagia typically involve altering the texture and consistency of foods and fluids to reduce the risk of aspiration and improve swallowing safety. This includes thickening liquids to a consistency that the patient can safely swallow, and modifying food textures by pureeing or softening solid foods to ease chewing and swallowing NICE CG32,NICE NG236.

Swallowing techniques recommended include compensatory strategies such as the Mendelsohn manoeuvre, chin tuck, and pacing of swallowing, which help improve airway protection and bolus control during swallowing NICE NG236 Logemann 1999. Postural adjustments, such as sitting upright or specific head and neck positions, can also facilitate safer swallowing NICE CG32,NICE NG236.

Behavioural exercises, including resistance exercises like chin tuck against resistance, and sensory stimulation techniques (thermal or tactile stimulation) are advised to enhance swallowing function when performed regularly, typically at least 5 days per week NICE NG236 Logemann 1999. Mouth care is essential to reduce the risk of aspiration pneumonia in dysphagic patients NICE NG236.

In children and young people with neurological conditions such as cerebral palsy, individualised management plans should include postural management, texture modification, feeding techniques (e.g., spoon placement and pacing), specialised feeding equipment, and environmental optimisation to support safe and effective eating and drinking NICE NG62.

Referral to speech and language therapists with expertise in dysphagia is crucial for assessment and tailored intervention, including advice on exercises, positioning, and diet modification NICE CG32,NICE CKS. Regular monitoring and reassessment of swallowing safety and nutritional status are recommended until the patient is stable NICE CG32,NICE NG236.

Shared decision-making is important, especially when patients at risk of aspiration choose to eat and drink without interventions; risks and benefits should be clearly communicated NICE NG236,NICE CKS.