What you need to know

• A stroke can change how you move food around in your mouth. It can change how well you can swallow. This is called dysphagia.
• Your hospital team will check how you swallow before you eat or drink.
• If you have dysphagia, food or drink can get into your lungs. This can make you very sick.
• Your speech pathologist will do tests to find out what has changed. They can tell you if you need to change how you eat and drink. They may be able to help you improve your swallowing.
• Your dietitian can give you advice on getting enough nutrition.
• If you can’t eat or drink safely, you may need alternative feeding.
  
  

About dysphagia

If you have dysphagia, you may have trouble:

• Breathing
• Swallowing
• Drinking
• Eating
• Taking medicines
• Controlling saliva.
  
  

Dysphagia can cause dehydration, malnutrition and weight loss.

About aspiration

If you have dysphagia, food or drink can go down the wrong way. It can go into your lungs instead of your stomach. This is called aspiration.

Signs include:

• Coughing
• Choking
• Shortness of breath
• A wet-sounding voice
• Fever.
  
  

Food or drink can get into your lungs without any of these signs. This is called silent aspiration.

The body’s natural response to aspiration is to cough the food or drink out. If you can’t, it may cause a chest infection. This is called aspiration pneumonia. It can make you very sick.

Managing dysphagia

Your hospital team will check how you swallow before you eat or drink. If there is a problem, they’ll ask the speech pathologist to do tests.

Your speech pathologist can:

• Watch how you chew and swallow different foods and drinks.
• Organise an X-ray. This is called a videofluoroscopy (VFS) or a modified barium swallow. This shows how your swallowing is working, and what exercises or treatment might help you. It also shows if food or drink is going into your lungs.
• Use a small camera to check your swallow. The camera is attached to a thin tube and inserted into your nose. This is called fibre-optic endoscopic evaluation of swallow (FEES).
  
  

Your speech pathologist can give you advice and help keep you safe. You may need to:

• Have a texture modified diet. This can include thick fluids, or soft food.
• Use different positions or movements when eating and drinking.
  
  

Your speech pathologist may give you exercises and treatment. This can include:

• Exercises to strengthen the muscles you use to swallow.
• Using different food or fluids to help the speed
  or coordination of your swallow.
• Using special devices in therapy.
  
  

A dietitian can give you advice on getting enough nutrition. You may need:

• Particular kinds of food and drink.
• To eat more or less food.
• Nutritional supplements.
  
  

Alternative feeding

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

A nasogastric tube (NG tube or NGT) is passed through one nostril down the back of your throat and into your stomach. An NGT can be used for up to a month.

You may need a percutaneous endoscopic gastrostomy (PEG) if:

• Your swallowing doesn’t improve
• If it will take a long time to improve.
  
  

This requires a small operation. A tube is inserted through the skin in your abdomen.

Special liquids go through the tube into your stomach. These liquids meet all your nutritional and fluid needs. Medications can also go through the tube.

Having a tube does not always mean that you cannot eat or drink at all. Sometimes you might use the tube for some things, and be able to eat or drink other things. Your hospital team will tell you if you can do this.

Before you go home

Your speech pathologist can tell you the signs that:

• Your swallowing is getting worse
• You are aspirating.
  
  

They will let you know what to do if this happens.

If you need a modified diet, they will tell you how to thicken fluids and modify foods to the right consistency.

If you’re going home with a PEG, the dietitian and PEG nurse will teach you how to manage it.

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.
  
  

Get help

StrokeLine’s nursing and allied health professionals can give you information, advice and support. StrokeLine is a free, confidential and practical service.

Open Monday to Friday, 9am to 5pm Australian Eastern Time. StrokeLine is closed on national public holidays.

1800 787 653
Email strokeline@strokefoundation.org.au 

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To find a speech pathologist

Speech Pathology Australia 1300 368 835
speechpathologyaustralia.org.au

To find a dietitian

Dietitians Australia 1800 812 942
dietitiansaustralia.org.au