A speech pathologist at LiveBig has provided us with some useful information about the processes involved in swallowing.
It’s important to know that eating, drinking and swallowing is so much more than food just going down into your child’s stomach. The process starts from when food is getting prepared to enter the mouth including factors such as how a person is seated, how they physically place food or drink in their mouth and also how someone responds to food using their senses such as sight, smell, taste and touch.
THE WHOLE SWALLOW
These are the three main processes involved…
- The Oral Phase… what happens in the mouth
2.The Pharyngeal Phase… what happens in the throat
3. The Oesophageal Phase… what happens in the food pipe
This first stage involves using the lips, cheeks, tongue and jaw for removing food or drink from a utensil and preparing it to be swallowed. Lips and the jaw open and close when taking food or drink from utensils and then the side to side and circular movement of the jaw when chewing food prepares a bolus (ball of food).
Strength and tension in the cheeks keeps the food or drink in the middle of the mouth and adequate strength means food or drink will not fall through between the cheeks and teeth.
The tongue has multiple roles to play. It tastes food or drink and moves food in the mouth for chewing. It also mixes food or drink with saliva, forms, controls, holds and pushes the bolus towards the top of the throat and it moves around the mouth to see if there is any food or drink remaining.
The Pharyngeal (throat)
This is also known as the ‘swallow reflex’ stage and is where the bolus moves through the throat and into the food pipe.
The parts of the mouth and throat in action here and their roles are:
The soft palate which lifts up and seals the gap between the nasal (nose) cavity from the back of the mouth and throat. This stops food or drink from travelling back into the nose.
The back of the tongue which squeezes against the back of the throat to push the bolus down the throat.
This stage is important to keep the airway protected. When the muscles are working correctly the following steps occur:
1. Vocal cords close and breathing stops temporarily.
2. The voice box moves upwards and forwards just below the base of the tongue.
3. A small flap called the ‘epiglottis’ acts like a trap door, closes over the voice box to create a seal over the airway.
This allows the food or drink to pass over the airway and into the food pipe.
The Oesophageal (food pipe)
This third stage of the swallowing process deals with how the food travels from the throat to the food pipe and into the stomach.
What if eating or drinking is difficult?
When a person has difficulty with eating or drinking, they may present with Dysphagia. This is the medical term used to describe swallowing disorders and it may occur in one or all three stages of swallowing.
Normal swallow function means food or drink can enter the stomach with no difficulties but in a person with dysphagia food or drink may enter the airway.
The following factors may increase the risk of Dysphagia:
Congenital abnormalities (e.g. clefts)
Injuries or disease
Degenerative diseases (e.g. Parkinson’s Disease)
Severe breathing difficulties
Weakness in lip, tongue or jaw muscles
Refusal to eat or drink
Dentition (the arrangement or condition of the teeth)
If someone has Dysphagia, the following may occur during or shortly after eating or drinking:
• Change in voice (e.g. wet and gurgly) after swallow
• Throat clearing during eating and drinking
• Shortness of breath
• Raised body temperature with a wet cough
Additionally, the following may occur over a period of time:
• Severe breathing difficulties
• Aspiration pneumonia (fluid/infection in the lungs)
• Weight loss
• Poor oral hygiene if there is food regularly remaining in the mouth
• Longer eating times
• Depression due to difficulty with eating and drinking
• Reduction in social/group outings due to difficulty with eating and drinking
• Dehydration or malnutrition if a person is not eating or drinking enough due to their difficulties
In people with extreme swallowing issues, an alternative method of getting food and drink into the body may be considered. This may include:
• Intravenous Fluids (IV) – Fluids are given via a ‘drip’ for hydration purposes.
• Nasogastric Tubes (NGT) – involves the use of a thin tube which passes ‘feeds’ (liquidised food) from the nose through to the food pipe and stomach. Percutaneous Endoscopic Gastronomy (PEG) – a medical procedure where the feeding tube is placed directly into the stomach allowing ‘feeds’ to go through.
• Total Parenteral Nutrition (TPN) – uses a needle or catheter to pass all nutritional needs straight into the bloodstream.
If your child is experiencing issues who can help?
A speech pathologist can assess a person’s swallowing skills. They may complete a mealtime assessment to observe your child’s eating, drinking and swallowing skills and they will work with the child, their families, carers, support coordinators or supporter workers to develop a mealtime management plan or therapy plan to help support the person’s swallowing skills.
How is this funded?
A swallowing assessment, mealtime plan and ongoing management can be funded by your NDIS plan. The Speech Pathologist may recommend special supports required for eating and drinking such as spoons or modified cups. This can be purchased under ‘Consumables’ in the ‘Core Supports’ budget in your plan.
• Always dial 000 and request immediate assistance in the case of an emergency or choking episode.
• Contact a GP for any issues related to any general health decline, including but not limited to: ongoing chest infections, raised body temperature with a wet cough, loss of appetite and weight loss
LiveBig is a specialist allied health and assessment services provider for people with disability. Call 1300 390 222 or visit livebig.com.au/service/ speech-pathology/ to find a Livebig Speech Pathologist near you.