What is dysphagia?
Dysphagia is the medical term for difficulty swallowing. It occurs when there is a problem with the neural control or the structures involved in any part of the swallowing process. Dysphagia can occur in all age groups, from infants to the elderly, but is more common in older adults. Some common causes of dysphagia include:
- Stroke
- Neurological disorders like Parkinson’s disease, multiple sclerosis, or muscular dystrophy
- Head and neck cancers
- Injuries or surgeries affecting the head, neck, or esophagus
- Gastroesophageal reflux disease (GERD)
- Developmental delays in infants and children
Dysphagia can result in serious complications if left untreated, including malnutrition, dehydration, aspiration pneumonia, and airway obstruction. That’s why it’s so important for patients with difficulty swallowing to follow an appropriate diet under the guidance of a speech-language pathologist or registered dietitian.
What foods should dysphagia patients avoid?
In general, people with dysphagia need to avoid foods that could increase their risk of choking. This includes foods that are:
- Hard, dry, or crunchy
- Chewy, sticky, or gummy
- Smooth, slippery, or easily molded into a bolus
- Sharp or spiky
- Tough, fibrous, or stringy
- Crunchy or contain seeds/pits
More specific foods to avoid include:
- Dry breads, crackers, cereals, granola
- Raw fruits and vegetables
- Tough, gristly, or dry meats
- Sticky foods like peanut butter or overcooked oatmeal
- Crunchy foods like chips, pretzels, nuts, or popcorn
- Foods with skins, hulls, or membranes like corn, grapes, or beans
- Any food that needs extensive chewing
What foods are safe for dysphagia patients?
People with dysphagia need soft, moist, easy to swallow foods prepared in the right texture. Here are some of the best options:
Beverages
- Water, juice, milk, coffee, tea, nutritional supplement drinks
- Thin liquid nectars and shakes (may need to thicken for some patients)
- Avoid thin liquids that could be accidentally inhaled like water or juice
Breads, Grains, Cereals
- Moistened breads, rolls, muffins, or pastries
- Cooked cereals like oatmeal, cream of wheat, or rice porridge
- Pasta, rice, quinoa, or other grains cooked very soft
Fruits and Vegetables
- Soft peeled and cooked fruits like applesauce, bananas, peaches, pears
- Well-cooked tender vegetables with no strings or membranes
- Pureed fruits and vegetables
Protein Foods
- Finely ground, bite-sized pieces of tender, moist meats
- Moist protein options like eggs, tuna salad, chicken salad
- Thick pureed beans, lentils, chickpeas
- Soft casseroles, lasagna, ravioli
- Cottage cheese, ricotta cheese, yogurt
- Hummus, refried beans
Mixed Dishes
- Well-moistened casseroles, stews, soups
- Macaroni and cheese, risotto, mashed potatoes
- Omelets, quiches, frittatas
- Pancakes, waffles, French toast
Desserts
- Puddings
- Custards
- Yogurt
- Ice cream, sorbet
- Gelatin
- Moist cakes and cookies
What food textures are recommended for dysphagia patients?
Dysphagia patients are often prescribed a specific food texture or liquid thickness tailored to their particular swallowing impairment. Here are some of the most commonly recommended dysphagia food textures:
Thin Liquids
Description: Flows like water, milk, juice, tea, coffee
Risk: Can be accidentally inhaled into lungs
Nectar-thick Liquids
Description: Thicker than thin liquids but thinner than honey. Pours in a continuous stream.
Risk: Reduced risk of aspiration.
Honey-thick Liquids
Description: Flows slowly in a thin stream when poured.
Risk: Allows more control when swallowing.
Spoon-thick Liquids
Description: Can be scooped up with a spoon. Hold shape on spoon briefly before falling off.
Risk: Allows time to initiate swallow.
Pureed Foods
Description: Smooth, cohesive, pudding-like texture. No lumps.
Risk: Easier to swallow, little chewing needed.
Mechanical Soft Foods
Description: Soft, tender pieces that hold shape. Requires some chewing.
Risk: May be difficult for very weak chewers.
Regular Foods
Description: Normal everyday foods. Require chewing ability.
Risk: Choking hazard if chewing or swallowing is impaired.
Tips for preparing dysphagia-friendly foods
Here are some tips to make foods easier and safer to swallow for people with dysphagia:
- Cut foods into small pieces no larger than 1⁄2 inch.
- Moisten dry foods with broth, sauce, gravy, or dairy products.
- Marinate meats to make them very soft and moist.
- Cook fruits and vegetables until very soft. Puree if needed.
- Trim meats of excess fat, skin, gristle, bone.
- Avoid mixed food textures (crunchy with soft).
- Thicken liquids to a safe consistency if needed.
- Serve foods warm or at room temperature (not piping hot).
Sample menu for a dysphagia diet
Here is a sample one day menu that provides nourishing foods appropriate for someone with dysphagia:
Breakfast
- Oatmeal cooked to a pudding consistency
- Moist scrambled eggs
- Sliced soft peeled peach
- Coffee with milk, nectar-thickened
Lunch
- Chicken and rice soup, thickened to spoon-thick consistency
- Tuna salad sandwich on soft white bread, crusts removed
- Applesauce
- Tea with honey, thin liquid
Dinner
- Swedish meatballs in gravy over mashed potatoes
- Green beans, cooked soft
- Dinner roll, soaked in broth
- Vanilla pudding
- Iced coffee, nectar-thick
Snacks
- Cottage cheese
- Banana slices
- Peach yogurt
- Oatmeal raisin cookie softened in milk
Important considerations when eating with dysphagia
Along with sticking to the right foods and textures, other tips for safe, enjoyable mealtimes with dysphagia include:
- Take small bites and sips. Chew thoroughly before swallowing.
- Sit upright while eating. Don’t lie down or recline.
- Take your time. Go slowly and rest between bites.
- Alternate solids with liquids in each bite.
- Minimize distractions during meals.
- Adapt utensils if needed (angled plates, built-up spoons, foam on handles).
- Schedule daily weight checks to prevent unintended weight loss.
Staying adequately nourished is extremely important for people with dysphagia. Work closely with your speech-language pathologist and dietitian to create a customized eating plan that provides both enjoyment and safety at mealtimes.
Conclusion
Dysphagia can significantly impact a person’s ability to eat and drink safely. However, with the right diet modifications, safe swallowing is possible. The keys are sticking to moist, soft, cohesive foods in the appropriate textures, avoiding choking hazards, preparing foods properly, and eating slowly and carefully. With guidance from medical professionals and some creativity in the kitchen, most dysphagia patients can find satisfying foods to promote adequate nutrition and hydration. Proper eating opens up a world of enjoyment and health, despite swallowing difficulties.