Feeding a Patient With Dysphagia: Foods and Tips

Feeding the Patient with Dysphagia

Dysphagia, also referred to as Difficulty in Swallowing, is a common disorder that may be caused by neurological disease, stroke, mesothelioma, especially pleural mesothelioma, inflammation, esophageal spasm (sudden squeezing of esophagus muscles), scleroderma (esophagus tissues become hard and narrow), dementia, and other factors.

Although it can affect anyone, the disorder tends to be more common in older adults, babies, and people with complications of the brain or the nervous system.

With this condition, it usually takes more effort to transport food from the mouth to the stomach.

Some of the symptoms of dysphagia include choking when eating, recurrent heartburn, coughing or gagging when swallowing, bringing food back up, drooling, a sensation of food getting stuck in the throat or chest, including others.

Now apart from increasing the risk of choking and aspiration, this condition also increases the likelihood of malnutrition and dehydration over time.

If you suffer from dysphagia, it’s crucial to make necessary diet adjustments in order to obtain enough fluids, essential nutrient, and energy needed for proper body function.

What are the Features of a Dysphagia Diet?

A dysphagia diet is a special type of diet that consists of different textures of foods and liquids that are easier to chew and safer to swallow. The food/liquid textures help reduce the negative effects of the disorder such as choking or gagging.

While ensuring that the food is easy to chew and safe to swallow, it’s important to ensure its well-balanced too.

Now dysphagia foods/liquids can be classified in a number of ways according to thickness- from thin liquid to solid, bite-sized foods.

Let’s have a look recommended foods/liquids depending on their consistencies/textures. We will also discuss the foods/liquids to be avoided on this diet.

Level 1: Puree Foods/Extremely Thick

This diet consists of pudding-like foods- foods that are pureed, homogenous, and cohesive. They should pretty much have a mashed potato-like consistency that holds shape in a spoon, not spill over.

You can even add a thickening agent to give some foods a good consistency. Good examples of Level 1 foods include;

  • Thinned cooked cereals
  • Pureed meats, fish, and poultry
  • Pureed scrambled eggs and cheese
  • Baby cereals
  • Pureed ham, tuna, and chicken salad
  • Pureed vegetables(avoid peas and corn)
  • Mashed potatoes
  • Pureed candled sweet potatoes
  • Decaffeinated Coffee/Tea
  • Ice cream
  • Pureed fruits
  • Thick milkshakes
  • Plain yoghurt
  • Cream
  • Whipped gelatin

#Foods to avoid in level 1: Foods that do not puree into a smooth consistency should be avoided as they may make swallowing much more difficult. This means that all tough foods like meats and some seeds should be thoroughly pureed before consumption.

Level 2 Foods/Liquids or Dysphagia Mechanical Soft Diet

Also commonly known as “Minced and Moist,” this diet consists of foods with moist, soft texture.

Vegetables should be properly cooked and easy to chew. All meats should be well ground, no large chunks whatsoever.

All foods should be thoroughly chopped or mince into tiny pieces, preferably 1/8”.

Recommended foods in this group include;

  • Minced meat, poultry, fish
  • Flaked fish
  • Minced soft cooked, poached/scrambled eggs
  • Minced stuffed fish
  • Cooked cereals
  • Minced vegetables
  • Cottage cheese
  • Milkshakes
  • Minced potatoes
  • Yoghurt
  • Semi-thickened fruit juices
  • Cream
  • Rice pudding and tapioca
  • Creamed soups
  • Gravies

#Foods to avoid in level 2: Avoid floppy textures such as raw spinach and lettuce. The foods should not contain any seeds, husk, crust, or skin as it may become difficult to eat and swallow as well. Also, try to avoid fibrous, chewy, crumbly, and crispy foods.

Level 3: Ground Foods

Foods in this level should be diced/ground into a quarter inch pieces, more or less like the size of rice.

This texture requires some chewing and tongue control. The foods should also be soft and tender.

Examples of foods in this group include;

  • Ground meat, poultry, and fish
  • Ground Swedish meatballs
  • Ground meat salads (avoid raw eggs)
  • Ground potatoes
  • Cooked cereals
  • Cottage cheese
  • Ripe bananas
  • Ground poached eggs
  • Ground canned vegetables
  • Pureed vegetables
  • Cream
  • Ground canned fruits
  • Ground soft French toast
  • Decaffeinated coffee/tea

#Foods to avoid in level 3: Avoid seeds, foods with husks, and skin like whole-grains, corn, peas, including others.

Level 4 Foods: Chopped Foods

Foods in this group should be chopped into small pieces. They should be tender and easy to break with a fork. The size should be similar to croutons.

Examples of chopped foods in Level four include;

  • Chopped meat or poultry
  • Scrambled or poached eggs
  • Meat salads
  • Chopped Swedish meatballs
  • Cooked cereals
  • Chopped pasta/noodles
  • Omelets
  • Milkshakes
  • Yoghurt
  • Ice cream
  • Whipped gelatin
  • Cheese
  • Creamed vegetable soup
  • Chopped pancakes

#Foods to avoid in level 4: Avoid very hard, crunchy or sticky foods.

Level 5: Modified Regular Foods

In this level, all foods are acceptable. They should be soft, moist, and regularly textured e.g. crunchy, crispy, tough, and may contain seeds or husks.

This diet is ideal as long as you can produce enough saliva and chew well enough to form a bolus, which is safe for swallowing.

Examples of foods in Level 5 include;

  • Soft meats, poultry, and fish
  • Meat salads
  • Cooked cereal
  • Eggs
  • Baked fish
  • French toast or pancakes
  • Spaghetti
  • Yoghurt
  • Pasta/noodles
  • Gravies
  • Potatoes
  • Fruit ice
  • Peeled, fresh fruit

Tips to Ensure You’re Getting Proper Nutrition

The fact that a dysphagia diet is complicated doesn’t mean that it shouldn’t be well-balanced. Use these tips to ensure you’re getting the right and enough nutrition.

  • Consume a wide variety of foods to ensure your body gets essential nutrients.
  • Eat small, frequent meals.
  • Chew small bits- large bits may be difficult to swallow.
  • Eat both hot and cold foods to provide a variety of temperatures in the diet.

Positioning for Feeding the Patient with Dysphagia

Now that you know what consistency of foods and liquids you are supposed to feed the patient, it’s also important to learn the correct positions and techniques to use when feeding the patient to reduce aspiration.
Aspiration is the entry of materials such as food, liquids, or stomach contents into the airway and lungs by accident, which can lead to serious complications.

Here are some of the most effective body positioning and techniques that minimize aspiration in patients with dysphagia.

1# Sit the Patient in An upright, Erect Position: Sit the patient in a way that he/she is upright in an erect position. If unable to position themselves, you can prop them up with a few pillows.

2# Patient Should be Positioned Head Tilted Forward/Chin Down: Assist the patient to tilt their head forward with their chin in a slightly forward position. It helps open the passage down to the oesophagus, unlike the head tilted back position which makes swallowing more difficult.

3# Place food in the Stronger Side of the Mouth: If the patient has a facial weakness, be sure to place food onto the stronger side of the mouth. This is especially important as it will not only allow for maximum feeding, but also improve safety during feeding.

4# Add more Support to the Impaired Side of the Patient’s Body: If one side of the patient’s body is weaker than the other, be sure to support the weaker side during feeding. This will make it much easier for the force of gravity to bring food bolus downward and pass through the impaired side with great ease.

5# Position Yourself at or Below your Patient’s Eye Level: Sitting at or slightly below the patient’s eye level will make it easier for him/her for keep and maintain their head in the best feeding position and also allow them to feed much more comfortably.

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