I have difficulty swallowing food or drink

I sometimes cough and splutter when I eat or drink

Coughing and/or spluttering when you eat or drink happens to us all sometimes.  A bit of food or fluid goes down the wrong way and enters our airway, and we have to cough to get it to go away.

For some people, this happens more frequently, and that can be a sign that they have difficulty swallowing. If you think this may be happening to you, please speak to a doctor or nurse, who can refer you for a swallowing assessment by a speech and language therapist (SALT).

What is dysphagia?

When we swallow normally, food, drink and medications go from the mouth down into the tube that leads to the stomach (oesophagus).

When someone has a swallowing problem, food and drink may ‘go down the wrong way’. This means that things may go down the tube that leads to the lungs (trachea) instead.

Food and drink ‘going down the wrong way’ is called aspiration. It may cause coughing and choking, but sometimes you may not even be aware that it is happening. If food, drink or medication get into the lungs they can cause a chest infection (aspiration pneumonia).

It is very important that we carefully manage any swallowing problems to:

• Reduce the risk of coughing and choking with food and drink
• Try and prevent aspiration pneumonia
• Make eating, drinking and taking medication as comfortable and enjoyable as possible
• Ensure enough food and drink is taken to maintain general health
• If you lose weight or lack variety in your diet you may benefit from referral to a dietitian. Please discuss this with your GP.

I have difficulty swallowing drinks

These are some of the symptoms you may be experiencing, as you are drinking or just afterwards:

• coughing
• spluttering
• eyes watering
• feeling short of breath.

This can mean that some of your drink is going into your airway instead of your food pipe, and it may be continuing into your lungs.  If that happens regularly, it can cause you to get chest infections, as your lungs try to fight off the foreign substance. 

Here are some things you can try, to avoid this happening:

• make sure you are sitting upright, preferably in a chair at a table
• drink from a wide rimmed cup or glass and avoid tilting your head back
• take one sip at a time, rather than ‘glugging’ your drink
• concentrate while you’re drinking; try to avoid any distractions
• have a thicker drink, e.g. a Horlicks or a milkshake, and see if you swallow it better.

I have difficulty swallowing food

These are some of the symptoms you may be experiencing, as you are eating or just afterwards:

• difficulty chewing certain foods
• effort required to swallow the food down
• coughing
• choking
• food getting stuck or moving slowly
• food coming back up.

You may find you are avoiding some foods you used to enjoy, e.g. nuts, biscuits, steak or salad. Try to avoid High Risk Textures and see if that makes a difference. 

Adding moisture to your foods (e.g. gravy, sauce, cream, custard) can often help it go down.  Here is some more advice to make swallowing safer and easier.

If you feel you can swallow, but have difficulty chewing your food because of problems with your teeth, please see a dentist.

I have difficulty swallowing tablets

If you are able to swallow food and drink, but find tablets difficult, try speaking to a pharmacist.  They can advise you on whether the particular tablet/s causing you trouble can be e.g. crushed or taken with a spoonful of yogurt.  Your GP can also help, and may be able to prescribe a dispersible version of the medication.

Unless you also have difficulty swallowing food or drinks, a speech and language therapist cannot help you with this.

Dysphagia recipe book 

General guidelines for helping with eating, drinking and swallowing

I am waiting to see a doctor about my swallowing – what can I do in the meantime?

If you are concerned about your swallowing, follow our general advice for safer and more comfortable swallowing while you wait to be referred for an assessment.

The golden rule of swallowing (PEARS)

I have been referred to a SALT and am waiting for my assessment

Once the SALT department has received a referral from your doctor or another medical professional asking us to look at your swallowing, we will try to call you to discuss your concerns in more detail.

A therapist may give you some advice to support your specific difficulties and discuss how best to conduct a Covid-safe swallow assessment.  This may be via a secure video consultation.

You may be provided with written information and advice to restrict your diet while you wait for assessment.

What happens in a swallow assessment?

Most assessments are conducted via a video link, using the secure NHS platform Attend Anywhere.  For this, you will need a device with a camera and microphone, such as an iPad or a laptop.

If you do not have a device or broadband, we will try to support you over the phone.

If neither a video, nor a phone, consultation is possible, we may be able to visit you at home for the assessment.  Your therapist will be wearing Personal Protective Equipment (PPE), to protect you and us from Covid-19.

Preparing for swallow assessment via Attend Anywhere

Attend Anywhere instructions for secure video consultations

Dysphagia and swallowing difficulties videos