People often assume swallowing is automatic and infallible, but I’ve learned it isn’t.
When my daughter was two months old, she caught RSV and stopped gaining weight. When she tried to feed, she coughed and sputtered, sometimes arching her back. She was soon diagnosed with dysphagia – a swallowing disorder.
“You’re lucky we caught this early,” the speech-language pathologist (SLP) said, after we watched a live X-ray of my baby swallowing. When she fed, her airway didn’t close entirely, causing a bit of formula to go down the wrong tube. The SLP explained that even a tiny amount of food or liquid entering the lungs can cause pneumonia.
Luckily, treatment was easy. I added thickening powder to her baby formula. Then, I gradually reduced the amount of powder, retraining the mechanisms in my daughter’s throat to swallow correctly.
This experience was one of the many reasons I became a speech-language pathologist myself. For the last eight years, I’ve worked with babies, children and adults with dysphagia. Last year, I experienced dysphagia as an adult when chronic acid reflux caused me to eat and drink more slowly.
Here’s what you can do to prevent, notice and – if needed – repair any issues.
How do you swallow properly?
There are simple ways to protect the health of the swallowing mechanisms. “The ‘right’ way and what feels natural may be a little different for everyone,” said Dr Laura Dominguez in Dallas, Texas, a board-certified otolaryngologist and fellowship-trained laryngologist specializing in voice and swallowing disorders. “Key things to remember are to take appropriately sized bites, chew well, and have water or some liquid available during meals.”
I and other SLPs coach children and adults to slow down when they’re eating solid foods, especially dry foods like sandwiches, sushi and meat. It’s also important to resist the urge to “knock back” or “chug” when drinking liquids. When we lean our heads back and quickly consume large amounts of liquid, gravity makes the structures in our throats work harder, increasing the risk for aspiration, or when something enters the airway.
Instead, it’s best to tilt the head only slightly when drinking, or use a straw. This allows gravity to support your swallowing.
What causes a swallowing disorder?
“Difficulty swallowing can happen along with any event that causes inflammation or irritation in the throat,” said Dominguez. “This can be short-lived, such as after an upper respiratory infection, or longer in duration, like after radiation therapy to the neck or spine surgery.”
For children, “swallowing disorders fall under the umbrella of a pediatric feeding disorder. Research has shown that one in about three dozen children under five years old are affected by a PFD,” said Amy Zembriski, a speech-language pathologist in New Jersey. She explained that childhood or adult swallowing disorders can be caused by anxiety, sensitivity to texture, or underlying medical diagnoses like gastrointestinal distress, neurological disorders or food allergies. Sometimes, the cause is unknown. “Swallowing uses over 30 muscles in our bodies, many cranial nerves, and quick coordination in order to move the foods and liquids that we consume safely from our mouths to our stomachs,” Zembriski said.
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One in 17 adults over the age of 45 are also diagnosed with dysphagia. “In adults, it often results from neurological conditions such as stroke, Parkinson’s disease or dementia, and can also occur as a natural part of ageing. The muscles involved in swallowing weaken over time, much like other muscles in the body,” said Stephanie Jeret, an SLP in Skokie, Illinois. Dysphagia can have a psychological root, or it can happen subsequent to gastrointestinal distress (ie gastroesophageal reflux disease, acid reflux and the like), which is on the rise in adults at all ages due to the use of GLP-1 agonists like Ozempic.
What is it like to live with dysphagia?
Some dysphagia is short-lived and can resolve with treatment, but sometimes, these disorders can last for months or years.
“Living with dysphagia can be extremely challenging,” said Jeret. “Some individuals may require a feeding tube, while others must avoid certain food textures or liquid consistencies to eat and drink safely.” Diet modifications, like pureed foods or thickened liquids, may be necessary “in preventing food or liquids from entering the airway and causing respiratory complications”.
Jeret and Zembriski both have children with feeding or swallowing difficulties. “Although I was knowledgable about the disorder in adults, it was overwhelming and frightening to navigate it as a parent,” she said.
Feeding and swallowing disorders “can significantly impact a child’s overall confidence and ability to connect with others at mealtime”, said Zembriski. Children who have experienced dysphagia may have higher anxiety or strict food preferences and may miss out on social events.
“Mealtimes can feel stressful, overwhelming, and like walking on eggshells,” she said. “Caregivers may feel like they are failing because their children may not be maintaining adequate nutrition, their children only eat a handful of foods, or well-intentioned family members and friends may be telling them that ‘they will grow out of it’ or ‘you just have to make them eat’.”
Dysphagia in adults can be acute when there is sudden inflammation in the throat or a food blockage. It can also be recurring or chronic. John Paul Andersen, a biomedical scientist in Lehi, Utah, developed a swallowing disorder as an adult. “My dysphagia first manifested when I was 30. I was eating steak and suddenly realized it was stuck, and nothing could get around it – not even saliva,” he said. “I now have to eat all my meals mindfully, which is a huge nuisance, but I learned to live with it.”
“Dysphagia is more prevalent than many realize and can significantly impact quality of life,” said Jeret. “Early identification and intervention are key to reducing health risks and helping individuals eat and drink with greater safety, confidence and dignity.”
I have lived with a mild swallowing disorder for a year, which I first noticed when solid foods felt like they were going down much slower than usual. Because of my experience as a clinician, I already ate mindfully, but have had to slow down even more. I didn’t realize how quickly my family and friends sped through meals until I had to wait several seconds to swallow each bite. I’d prefer to have an easier time eating, but I savor food differently now – it’s almost meditative. Breathing and swallowing happen in such close proximity, and taking my time with both reminds me how fragile these ordinary processes can be.
