Swallowing, Dysphagia, and Feeding Problems

This worksheet discusses the various aspects of swallowing, the definitions and causes of dysphagia, and various occupational therapy treatments for feeding disorders.

Anatomy of the Mouth and Throat

The anatomy of the mouth and throat plays a critical role in the swallowing process. Below is an overview of the key structures and their function during feeding:

Oral Motor Skills During Eating

Eating involves using a range of oral motor skills that help prepare food and liquids for swallowing:

Phases of Swallowing

Swallowing is a complex process that occurs in four distinct phases:

1. Oral Preparatory Phase
   • Food is chewed (mastication) and formed into a soft mass called a bolus.
   • This is a voluntary phase and varies in duration based on food texture.
2. Oral Phase
   • The tongue pushes the bolus to the back of the mouth, triggering the swallowing reflex.
   • This is a voluntary phase; typically lasts 1-3 seconds.
3. Pharyngeal Phase
   • The swallow reflex is initiated, and the larynx closes to protect the airway.
   • This phase is involuntary and takes about 1-3 seconds.
4. Esophageal Phase
   • The esophagus contracts to move the bolus toward the stomach.
   • This phase is involuntary; lasts 8-10 seconds.

What is Dysphagia?

Dysphagia refers to difficulty or discomfort in swallowing that persists over a prolonged period of time. It can impact an individual’s ability to eat safely, which may lead to malnutrition or aspiration.

2 Types of Dysphagia

Dysphagia Diet: Framework for Dysphagia Management

Patients with dysphagia may require modified diets to make eating and drinking safer. Liquids and foods are often thickened or altered in texture to prevent choking and aspiration.

Liquid Consistencies

Consistency	Description	Examples
Thin	Normal liquid that flows freely.	Water, tea, juice.
Nectar	Slightly thickened to slow flow.	Tomato juice, smoothies.
Honey	Moderately thick; drips slowly.	Honey, syrup.
Pudding	Extremely thick; does not drip or flow.	Pudding, ice cream

Food Consistencies

Level	Description	Examples
Level 4	Pureed; pudding-like texture.	Mashed potatoes, applesauce.
Level 5	Mechanical soft; easy-to-mash, soft foods.	Ground meat, mashed veggies.
Level 6	Soft solid foods, cut into small pieces.	Soft fruits, diced chicken.
Level 7	Regular; normal food that requires chewing.	Normal diet.

Occupational Therapy Treatments for Dysphagia

Occupational Therapy Practitioners (OTPs) play a key role in addressing feeding and swallowing issues by implementing interventions tailored to the patient’s individual needs.

General Feeding Guidelines:

1. Ensure all dietary restrictions and food consistencies are followed.
2. Check food temperature before serving.
3. Seat patients in a proper seated position to encourage safe feeding.
4. Make sure the patient is alert and prepared to eat.

Examples of OT Interventions:

Final Thoughts

Dysphagia can significantly impact daily life, but with a structured approach and support from OTPs, feeding and swallowing challenges can be managed effectively. Modifying food textures, positioning, and implementing specific oral-motor and swallowing exercises can greatly enhance a patient’s ability to eat safely and independently.Liquid Consistencies

For those experiencing ongoing difficulties with swallowing, it is essential to consult a physician and with a team approach, which includes OTPs and speech-language pathologists, the best course of action can be determined.