What you need to know 

• A stroke can affect the way you move food around in your mouth and how well you can swallow. This is called dysphagia.
• Dysphagia can cause problems with eating and drinking. Food or drink might go down the wrong way and get into your lungs.
• Your speech pathologist can help you manage dysphagia.

If you have dysphagia, you may have difficulty breathing, drinking, eating, swallowing and controlling your saliva.

Dysphagia can cause aspiration. This is when food or fluids go into your lungs rather than your stomach. The body’s natural response when food or fluid go into your lungs is to cough them out. If you cannot cough adequately, it can cause life-threatening chest infections. This is called aspiration pneumonia.

Signs of aspiration include coughing, choking, a wet-sounding voice and shortness of breath. Silent aspiration is when food or fluids get into your lungs without any of these signs.

Because dysphagia can make it difficult to eat and drink. It can also result in dehydration, weight loss, malnutrition and problems taking your medications.

Managing dysphagia

A dietitian can help make sure you are getting adequate nutrition. This may mean having particular types of foods and drinks, eating more or less food and taking nutritional supplements.

Guidelines for healthy eating

After a stroke, a member of the treating team should check your swallowing before you eat, drink or take medicines by mouth. If you have problems swallowing, you will be referred to a speech pathologist.

The speech pathologist will check the muscles you use to swallow. They may:

• Watch how well you chew and swallow different foods and drinks.
• Request an X-ray to see if food or drink is going into your lungs. This is called a videofluoroscopy (VFS) or a modified barium swallow.
• Use a small camera to check your swallow. The camera is attached to a thin tube and inserted into your nose. This is called fibreoptic endoscopic evaluation (FEES).

After these tests, the speech pathologist may recommend assistance or supervision when you eat or drink. They may recommend you only drink thickened drinks and eat softer or smoother food that is safe for you. They may also suggest particular positions or movements that make swallowing safer or easier.

Your speech pathologist may also work with you to develop a rehabilitation program. It may include:

• Exercises to strengthen the muscles used for swallowing.
• Very cold swabs or ice applied to you swallowing muscles just before you swallow.
• Electrical stimulation of the muscles used for swallowing.

Alternative feeding

If you have a lot of trouble swallowing you may need alternative feeding.

For up to a month after your stroke, alternative feeding will be through a nasogastric tube (NG tube or NGT). This tube is passed through one nostril down the back of your throat and into your stomach.

If your swallowing is not expected to improve, or will take a long time to improve, your team may recommend a percutaneous endoscopic gastrostomy (PEG). This requires a small operation where a tube is inserted through the skin in your abdomen. Special liquids that meet all of your nutritional and fluid requirements go through the tube into your stomach. Medications can also be fed through the tube. You and your family will be shown how to manage PEG feeding at home if needed.

Your family and friends can help

Everyone who helps you with eating, drinking and taking medicine should know how to make swallowing safe for you. The speech pathologist can provide your family and friends with information about:

• Food and drinks to avoid.
• How to thicken fluids and modify foods to the correct consistency.
• How to position your head and body when swallowing.
• Exercises to strengthen the muscles used for swallowing.
• Recognising signs your swallowing problem is getting worse, or that you are aspirating and what to do.

More Help

The health professionals at StrokeLine provide information, advice, support and referral. StrokeLine’s practical and confidential advice will help you manage your health better and live well.

Call 1800 STROKE (1800 787 653)
Email strokeline@strokefoundation.org.au

Join Australia’s online stroke community with videos, fact sheets, resources and support for stroke survivors, their family and friends.
enableme.org.au

To find a speech pathologist
Speech Pathology Australia 1300 368 835
www.speechpathologyaustralia.org.au