The ability to swallow effectively and safely is a basic human need. Any alteration or delay in the swallowing process causes dysphagia (difficulty swallowing). Aspiration pneumonia can be a fatal complication of dysphagia. The goal of dysphagia evaluation and management is to ensure that a patient will be able to swallow oral fluids and food safely. The single most important measure to prevent aspiration is to place the patient on NPO status until a swallowing evaluation determines that dysphagia poses no substantial risk. Bedside screening for dysphagia includes giving the patient water or foods with different textures and observing for coughing, gagging, choking, and voice alteration.

Dysphagia management includes dietary modification by altering the consistency of foods and liquids and is most effective when implemented using a multidisciplinary approach. The speech-language pathologist (SLP) and registered dietitian (RD) are central to dysphagia management.

Four levels comprise the National Dysphagia Diet: dysphagia puree, dysphagia mechanically altered, dysphagia advanced, and regular (Table 4-1). Thin liquids create safety risks in swallowing because of their speed and decreased texture for patients with impaired oral motor control. Thickened liquids are commonly prescribed to prevent aspiration pneumonia. Nectarlike liquids (medium viscosity) are liquids that are thickened but drip off a spoon at a slower rate than thin liquids. Honeylike liquids (high viscosity) are thickened so the liquid drips off a spoon at a much slower rate. Spoon-thick viscosity liquids include foods that do not easily drip off a spoon. It is important to remember that the desired thickness of a liquid depends on the patient’s swallowing deficit.

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