The Safety Net

Having A Safe Mealtime

We all want a pleasant and safe mealtime. If you have a disability or eat with a family member or friend with a disability who has difficulty with eating and drinking, then special knowledge is helpful to make this a safe and pleasant experience.

The difficulties experienced with eating may be due to poor posture or poor head control and/or limited movement of the lips, jaw or tongue. Difficulty swallowing may be referred to as "dysphagia". Dysphagia may be a symptom of other problems such as some kind of damage to the nervous system, a stroke, spinal cord injury or cerebral palsy. It can also be the side effect from some medication.

*General Signs of swallowing problems:

• Coughing during or right after eating or drinking. This is not normal and should result in a thorough examination.
• Wet or gurgly sounding voice during or after eating or drinking.
• The person may need extra effort or time to chew or swallow.
• You may observe food or liquid leaking from his/her mouth or getting stuck in the mouth.
• Recurrent pneumonia or chest congestion after eating or drinking.
• Weight loss or dehydration from not being able to eat or drink enough.

*Thanks to www.asha.org, the American Speech-Language-Hearing Association for this list. Visit their site for more information.

When a person experiences difficulty swallowing, they should be evaluated by their physician, and, if possible, a speech language pathologist, a physical therapist, an occupational therapist and a nutritionist. The family should participate and, to the extent possible, teachers, nurses and others involved in the daily life of the individual with the swallowing problem. Everybody does not have to gather in one room on the same day but these are the specialists who should examine or consult about the individual with Dysphagia. 

In order to have a mealtime that is safe, it is important to have a plan that is developed with the input of all those who have examined the individual. Every person is different! Do not attempt to guess what the person needs. The plan must include the following:

• The correct texture of food and liquids; some examples are pureed, minced, ground, chopped, and modified regular. Liquids may be thickened until they are acceptable to the therapist.
• The correct adaptive equipment. This means that if a coated spoon is required, a metal, uncoated spoon is not acceptable. There are adapted plates, cups and silverware that can add to the person's independence while helping get the food to the right place with minimal spillage.
• The correct positioning. Some people need a specialized chair that will adjust for proper alignment during meals. Still others may need specialized foot rests and bolsters. Often the person will need to be repositioned throughout the meal. The method used to present food should be described. If the person does it himself, then it is important to describe where everything is placed. If actual physical assistance is provided, then it is important to know how the assistant should be placed. It is very difficult to swallow if the head is tilted too far back. Head alignment must be done as the therapist has described. Every person who may assist another with a meal needs to know the exact details of the Plan so it should be kept nearby.
• A pleasant and relaxing environment is very important. Mealtime still needs to be a social experience. It is a time to be together, share and enjoy. 

Following these guidelines should lead to a safer and more pleasant mealtime for everyone.