Swallowing problems

Swallowing problems occur when a person has trouble getting food or liquid down their throat. A person may gag, cough, spit, or feel pain when trying to swallow. There can be a number of causes. It may be a short-term side effect of chemo or radiation treatment to the throat or chest. It may also be caused by an infection of the mouth or esophagus (the swallowing tube that goes from the throat to the stomach), as well as other problems.

What to look for

• Gagging, coughing, or vomiting of food
• Weight loss
• Food building up in mouth
• Drooling out of the side of mouth; too much saliva
• Little or no saliva
• Inside of mouth is red, shiny, glossy, or swollen
• Open sores in mouth
• Pain in throat or mid-chest when you swallow
• Feeling like the food is "sticking" on its way down
• White patches or a coating on the inside of the mouth

What the patient can do

• Eat bland foods that are soft and smooth but high in calories and protein (such as pudding, gelatin, ice cream, yogurt, and milkshakes).
• Take small bites, and swallow each bite completely before taking another.
• Use a straw for liquids and soft foods.
• Try thicker liquids (such as fruit that has been pureed in the blender), because they are easier to swallow than thin liquids.
• Mash or puree foods (such as meats, cereals, and fresh fruits) so that they are as soft as baby food. You may need to add liquids to dry foods before blending.
• Dunk breads in milk to soften.
• Refrigerate food (the cold helps numb pain) or serve cool or lukewarm. (Pain in the esophagus may feel worse with cold liquids. If so, serve food at room temperature.)
• Try crushed ice and liquids at meals.
• Frequent small meals and snacks may be easier to manage.
• Crush medicines in pill or tablet form; mix in juice, applesauce, jelly, or pudding. (Check with your nurse or pharmacist first, because some medicines can be dangerous if crushed or broken. Others react badly with certain foods or must be taken on an empty stomach.)
• Avoid alcohol and hot, spicy foods or liquids.
• Avoid acidic foods, such as citrus fruits and drinks, or fizzy drinks (like cola or ginger ale).
• Avoid hard, dry foods such as crackers, nuts, and chips.
• Sit upright to eat and drink and for a few minutes after meals.
• If pain is a problem, use a numbing gel or pain reliever, such as viscous lidocaine (by doctor’s prescription) or liquid Tylenol. (See the section called "Mouth sores.")
• Ask your doctor about seeing a speech therapist or swallowing therapist.

What caregivers can do

• Offer soft, moist foods. Baked egg dishes, tuna salads, and thick liquids such as yogurt may be easier to swallow.
• Avoid chewy foods or raw, crunchy vegetables.
• Sauces and gravies make meats easier to swallow.

Call the doctor if the patient:

• Gags, coughs, or chokes more than usual, especially while eating or drinking
• Has a severe sore throat
• Has a red, shiny mouth or ulcers in the mouth or on tongue
• Has a fever greater than 100.5° F when taken by mouth
• Has trouble breathing
• Has chest congestion
• Has problems with food "sticking" as it goes down
• Cannot swallow medicines or eat