A person may gag, cough, spit, feel pain, or have other problems 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 as you try to swallow
- Weight loss
- Drooling out of the side of mouth or the sense you have too much saliva (spit)
- Little or no saliva
- Inside of mouth is red, shiny, glossy, or swollen
- Open sores in the mouth
- Pain in throat or mid-chest when you swallow
- Feeling as if 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 cream-based soups, pudding, 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 or liquids with added thickeners), because they’re easier to swallow than thin liquids.
- Mash or puree foods (such as meats, cereals, and fresh fruits) so that they’re as soft as baby food. You might 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. If pain gets worse with cold foods, try food at room temperature.
- Try crushed ice and liquids at meals.
- Frequent small meals and snacks may be easier to manage.
- Crush pills or tablets and mix in juice, applesauce, jelly, or pudding. (Check with your nurse or pharmacist first, because some pills 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 and fizzy soft drinks.
- Avoid hard, dry foods such as crackers, pretzels, nuts, and chips.
- Sit upright to eat and drink, and stay that way for a few minutes after meals.
- If pain is a problem, use a numbing gel or pain reliever, such as viscous lidocaine (by prescription) or ask about taking pain medicine before eating. (See Mouth Sores.)
- Ask about seeing a speech-language pathologist 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.
- Sauces and gravies make meats easier to swallow.
Call the cancer team 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 of 100.5° F or higher when taken by mouth
- Has trouble breathing
- Has chest congestion
- Has problems with food “sticking” as it goes down
- Cannot swallow medicines or eat
For more on dealing with swallowing problems, see Nutrition for the Person With Cancer.
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Last Medical Review: June 8, 2015 Last Revised: June 8, 2015