To thicken or not to thicken?
This page contains the latest national guidance from the Royal College of Speech and Language Therapists, as well as links to resources and information on supporting safe eating and drinking.
Information updates and guidance
There have been recent changes to the evidence base surrounding the use of thickener to manage swallowing difficulties. The Royal College of Speech and Language Therapists (RCSLT) has recently published national information and guidance on the use of thickened fluids in the management of people with swallowing difficulties.
There is a helpful document for clinicians which summarises the changes in the use of thickened fluids in the management of drinking and swallowing difficulties (dysphagia).
The Gloucestershire Speech and Language Therapy (SLT) Department would like to issue some companion advice to the ‘key points’ section on the thickened fluids clinicians briefing. This advice is specific to our Trust:
- Speech and Language Therapists (SLTs) will sometimes recommend a short-term trial of thickened fluids following an initial triage assessment (e.g. via telephone) while the service user awaits formal assessment.
- Once a service user has been advised to have thickened fluids, the need for continued SLT review will be determined on an individual basis. For some, the recommendation for thickened fluids is long-term advice and does not always require regular or ongoing input.
- Please be mindful that thickener use can cause complications such as reduced fluid intake, dehydration, chest infections and constipation – for more details please refer to the potential adverse effects in the leaflet.
- Consider the impact of thickener on prescribed medications.
Please click on the below links for information relevant for patients and their carers/ relatives:
- Thickened Drinks Easy Read for children: RCSLT Easy Read Thickened Drinks Child
- Thickened Drinks Easy Read for adults: RCSLT Easy Read Thickened Drinks Adults
If you would like this information in an easy read or on audio format, please contact the Trust Communications Team at ghccomms@ghc.nhs.uk.
Guidelines to support safe eating and drinking
What can affect safe eating and drinking?
Sometimes people have a specific impairment of the muscles involved in eating and drinking. There are many pairs of muscles that have to work together to ensure food and drink can be effectively chewed, cleared from the mouth, and passed safely into the oesophagus (food pipe), whilst preventing it from entering the nose or airway.
There are many things that can affect safe eating and drinking. These could be more general physical or cognitive difficulties that make eating and drinking more difficult and potentially riskier. For example, if someone has difficulty sitting upright, food and drink may fall to the back of the mouth before they are ready to swallow, or pool in the side of the mouth unnoticed. If someone has difficulty sensing food in their mouth the messages may not be sent to their brain to trigger the swallow to start.
What are the risks?
One of the biggest risks faced by people who experience difficulties with eating and drinking is aspiration pneumonia. This is a chest infection caused by particles of food and/or drink passing into the lungs. The term ‘aspiration’ in this circumstance means foreign materials have passed into the airway below the level of the vocal cords.
Signs of Aspiration
Some people can aspirate without any obvious signs externally. In this case it is usually suspected due to repeated chest infections and confirmed by special examinations that use X-rays or cameras to see what is happening internally when someone swallows. However, some common external signs that someone may be aspirating are:
- coughing
- changes in face colour
- eyes watering
- wet ‘gurgly’ voice.
These signs occur during or very soon after eating and drinking.
What can I do?
Below are some general tips on how to improve a person’s safety when eating and drinking.
Please note, the below tips are general safety measures. It is important to also seek specific advice from a speech and language therapist.
Where possible, support the person to feed themselves rather than feeding them
This improves safety, as the person can control the amount of food/drink and the pace of eating. The movement of lifting food to the mouth can also help the brain anticipate the need to swallow. For some people with physical or cognitive difficulties who have difficulty feeding themselves, putting your hand over their hand and elbow to support them with holding and lifting a spoon/ cup can be much safer than just feeding them. We call this the ‘hand over hand’ technique.
Support the person to sit upright
Sitting fully upright for all food/ drink is especially important. Some people may need extra support, such as specialist seating, to ensure they are in an appropriate position.
Only offer food/drink when the person is fully awake
When a person is feeling tired or drowsy the muscles of the swallow do not work as effectively. This may mean eating at different times of the day, when a person feels at their best, or little and often throughout the day.
Encourage the person to eat/ drink slowly
If you support the person physically, ensure their mouth is empty before helping them with another sip/bite.
Be sociable but do not encourage the person to talk with food in their mouth
Mealtimes are good to engage in conversation. However, the airway has to be open for speech, so any food or drink in the mouth may pass into the person’s airway (‘go down the wrong way’) if they talk with food in their mouth.
Monitor with higher-risk foods
These are foods with textures that can be more difficult to manage, e.g. stringy fibrous foods; vegetable and food skins, e.g. beans/grapes; crunchy or crumbly items, e.g. toast or biscuits; very hard items, e.g. boiled sweets; and mixed consistencies, e.g. soup with lumps, hard cereals in milk, mince in thin gravy.
Stop if you are concerned
If there are any indicators that the person is not managing well – for example, they are coughing when swallowing or becoming more tired – encourage them to stop and try something later. If the problem persists talk to the speech and language therapist about further assessments, to ensure the risks are managed well.
