How to identify a swallowing difficulty

Throat pain while swallowing is mostly an indication of sore throat. Yet, there can be some other causes behind this condition as well. Read on to know more.

Throat pain while swallowing is mostly an indication of sore throat. Yet, there can be some other causes behind this condition as well. Read on to know more…

Do you constantly have a feeling of pain as if something is stuck at the back of your throat? Does the pain become worse when you try to swallow something? Well, you could be having sore or strep throat which is often the work of a virus or bacteria. Throat pain while swallowing can present as an independent condition or it may be a symptom of some other disease.

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Inflammation of tonsils and pharynx results in tonsillitis and pharyngitis. Tonsillitis or pharyngitis is the most common cause of sore throat or throat pain while swallowing. It can be either due to bacteria or virus. Bacterial pharyngitis is easier to cure as it responds well to antibiotics for strep throat. Viral pharyngitis may stem from common cold or similar infection. The mode of transmission of this virus is direct. The airborne virus comes in contact through the discharged droplets of the infected person. Paracetamol or ibuprofen may prove to be of great help in treating viral infections.

Glandular fever or ‘kissing disease’ is caused by Epstein-Barr virus (EBV). Along with sore painful throat, the person also experiences fever. About 95% of the world population has been infected by EBV at some or other point of time. The mode of transmission of this virus is through the saliva, with kissing being the most common means. Therefore, this disease is also called kissing disease. It is more prevalent in teenagers for obvious reasons.

The world has been so terrified with swine flu that even a normal strep throat patient is asked to undergo H1N1 test. This is because one of the major symptoms of swine flu is severe throat pain when swallowing. Broad spectrum antiviral medications are prescribed for swine flu.

Oral cancer or cancer of larynx may cause throat pain which worsens when swallowing. However, the cancer always need not be malignant. The cancer mostly originates in the glottis of the larynx, but eventually spreads to other organs as well.

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Sexually transmitted diseases such as chlamydia, gonorrhea are also responsible for sore throat and throat pain when swallowing. More often than not, women who perform oral sex on their partners are at risk of contracting the virus responsible for throat pain. Antibiotic drugs can be prescribed to cure it.

Throat pain is likely to subside on its own within a few days, if it’s a bacterial infection or viral infection due to common cold. However, if you feel lumps or notice redness at the back of your throat, you should see a doctor. Even in the absence of lumps, if the pain persists for too long, it is strongly advised that you see a doctor, without delay.

Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York.

There are several different causes of difficulty swallowing, including gastroesophageal reflux disease (GERD). Recurring swallowing problems can lead to problems such as poor nutrition, dehydration, getting more colds, and aspiration pneumonia.  

How to identify a swallowing difficulty

Difficulty swallowing (dysphagia) can occur when food does not pass normally from the mouth through the esophagus to the stomach.

You may have a sensation of food sticking in the throat, chest pressure, “burning” after eating, or a feeling of choking.   Dysphagia can be a symptom of GERD but also of other conditions, as well as complications of GERD.

Causes of Difficulty Swallowing

Several conditions can cause frequent difficulty swallowing, and this symptom should always be evaluated by a physician.

Difficulty swallowing is more common as you get older because certain conditions are more frequent as you age. The causes can be divided into two categories.

In esophageal dysphagia, food gets hung up while passing down your throat to your stomach. Causes include esophageal spasms, tumors, inflammation, food allergies, scar tissue, and the top culprit, GERD.  

With GERD, the contents of the stomach inappropriately leak into the esophagus and cause irritation.

In oropharyngeal dysphagia, you have trouble moving food from your mouth into your throat. Causes include neurological diseases such as Parkinson’s disease, multiple sclerosis, and muscular dystrophy.  

This type of dysphagia can also occur after a stroke or brain injury. And some types of cancer, as well as cancer treatments such as radiation, can also cause oropharyngeal dysphagia. And a pharyngeal diverticulum is a pocket that forms in the throat, potentially trapping food.

GERD and Difficulty Swallowing

GERD is a frequent cause of dysphagia.   Also, people with other conditions that can cause dysphagia are more likely to have difficulty swallowing if they also have GERD.

When GERD is not treated or is under-treated, it could result in serious complications such as erosive esophagitis and esophageal strictures.  

One of the symptoms of esophageal cancer, which is more common in people with GERD, is difficulty swallowing.  

If you experience any difficulty swallowing, it is important that you see your physician.

  • Chest pain: This pain usually starts behind the breastbone (the sternum), and may travel up to the throat. It usually occurs shortly after eating and can last from a few minutes to several hours.
  • Hoarseness, especially in the morning: Irritation caused by refluxed stomach acid into the throat can lead to a hoarse voice.
  • Persistent cough: If refluxed stomach acid is breathed in, it can cause coughing. This is a common cause of persistent cough in people who don’t smoke.
  • Bad breath: When acid from the stomach comes up into the throat and mouth, acrid-smelling, bad breath can result.  

A Word From Verywell

If you have frequent difficulty swallowing, this is an important symptom to discuss with your doctor. It may be a sign of a new condition or a condition that is getting worse. Besides being unpleasant, you may not be eating or drinking enough to maintain good health. Your doctor will be able to explore what the cause may be and decide on how best to relieve your symptoms.

By Lauren Mahakian Contributing writer. Originally published in Santa Ynez Valley News on 4/28/2021

The English language is filled with both simple and complex words. When someone uses an overly complex word in ordinary circumstances, they’re sometimes accused of using a ten-dollar word when a less expensive word would do.

Dysphagia might seem like a ten-dollar word used to describe trouble swallowing. Like most expensive words, however, there is much more to the meaning than we might see at first. There’s a reason these words exist, of course, and dysphagia is no laughing matter.

Dysphagia is a medical diagnosis associated with trouble swallowing. Unlike occasional difficulty swallowing, which might result from eating too quickly or not chewing food properly, persistent dysphagia often requires medical attention. When it occurs in people with dementia, it presents additional challenges for caregivers, especially family members who are neither trained to assist with dysphagia nor prepared to deal with family and other social impacts.

How common is dysphagia in dementia?

Dysphagia is surprisingly common among older adults, and more so among those with dementia and Alzheimer’s disease. In fact, studies suggest that over 20% of older adults live with dysphagia, with double that rate for those in care facilities. Dysphagia is even more common among those with dementia and worsens as the disease progresses. Some estimates suggest rates as high as 80% among those living with dementia in care facilities.

Studies point to multiple causes in dementia patients. These include causes related to memory, such as forgetting to chew or swallow. They also include damage to the brain that results in motor impairments or sensory impairments, just as similar damage leads to memory impairments. In these cases, damage occurs to parts of the brain that control swallowing, something most of us take for granted.

How to identify dysphagia

Chronic dysphagia is challenging to identify in its early stages. Most professionals describe early symptoms as subtle, only recognizable in hindsight long after they become worse. These symptoms commonly occur during meals, so vigilance at these times can help spot the situation early and indicate that it’s time to bring in a medical professional for evaluation and diagnosis.

If your loved one is diagnosed with dementia, be aware of the symptoms and don’t take small problems for granted. Many of the symptoms to watch for happen during or shortly after meals. Chewing may become a challenge, and your loved one may expend more energy and take more time to chew. Pay attention to how long your loved one holds food in their mouth, especially if accompanied by even minor choking. Coughing or throat clearing is common in dysphagia, notably after taking a drink. Drooling is equally common for many sufferers, including excess saliva production or spilling food or liquid out of their mouth. Many professionals also note wet or gurgly voices as a warning sign.

In the longer term, loved ones may completely stop eating certain foods and suffer weight loss or dehydration. Eventually, they may start avoiding meals altogether and isolate themselves.

As with most issues related to dementia, the key is to always remain calm and seek to understand how your loved one is feeling. Consult with professionals as necessary to help with the process.

Avoid certain food that your loved one has difficulty chewing or swallowing. Certain soft foods may be easier to eat. Some foods might need to be pureed or chopped, a so-called mechanical soft chopped diet that you can find with a quick internet search. Thicker fluids are also less likely to cause choking than watery liquids.

If your loved one is unable to feed themselves, you’re probably aware of the importance of positioning for eating. It’s tough for anyone to swallow with their head too far forward or backward — try it for yourself. You can help by sitting opposite your loved one at eye level. Eye contact then helps assure proper head position for swallowing.

Since we’re on this subject, we can’t ignore the importance of good oral hygiene. Ensure your loved brushes their teeth and maintains good dental practices since oral pain may make eating even more difficult. If your loved one wears dentures, consult with the dentist to assure they’re fitted properly and comfortably.

If you care for someone living with dementia, watch for signs of dysphagia. When in doubt, consult your physician or a speech and language therapist. Addressing these issues early will help both physical and mental health.

Lauren Mahakian is a certified care manager. Check out her free podcast, Unlocking the Doors of Dementia™ with Lauren and Free Support Groups on Zoom.

In this Article

  • How Do I Know If I Have a Swallowing Problem?
  • How Are Swallowing Problems Diagnosed?
  • How Are Swallowing Problems Treated?

Swallowing seems simple, but it’s actually pretty complicated. It takes your brain, several nerves and muscles, two muscular valves, and an open, unconstricted esophagus, or swallowing tube to work just right.

Your swallowing tract goes from the mouth to the stomach. The act of swallowing normally happens in three phases. In the first phase, food or liquid is contained in the mouth by the tongue and palate (oral cavity). This phase is the only one we can control.

The second phaseВ begins when the brain makes the decision to swallow. At this point, a complex series of reflexes begin. The food is thrust from the oral cavity into the throat (pharynx). At the same time, two other things happen: A muscular valve at the bottom of the pharynx opens, allowing food to enter the esophagus, and other muscles close the airway (trachea) to prevent food from entering the airways. This second phase takes less than half a second.

The third phase starts when food enters the esophagus. The esophagus, which is about nine inches long, is a muscular tube that produces waves of coordinated contractions (peristalsis). As the esophagus contracts, a muscular valve at the end of the esophagus opens and food is propelled into the stomach. The third phase of swallowing takes six to eight seconds to complete.

A wide range of diseases can cause swallowing problems, which your doctor may call “dysphagia.” These include:

  • Disturbances of the brain such as those caused by Parkinson’s disease, multiple sclerosis, or ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease)
  • Oral or pharynx muscle dysfunction such as from a stroke
  • Loss of sphincter muscle relaxation (termed “achalasia”)
  • Esophageal narrowing such as from acid reflux or tumors

How Do I Know If I Have a Swallowing Problem?

Under normal circumstances, people rarely choke during a meal. Occasionally, food will stick in the esophagus for a few seconds (especially solid foods), but will pass spontaneously or can be washed down easily with liquids. ButВ there are a number of symptoms that you should get checkedВ for a possible swallowing problem, including:

  • Frequent choking on food
  • Hesitancy in food passage for more than a few seconds
  • Pain when swallowing
  • Recurring pneumonia (an indication that food may be going into the lungs rather than the esophagus)

Immediate medical attention is needed when food becomes lodged in the esophagus for more than 15 minutes and doesn’t pass spontaneously or with liquids.

Some people don’t know that they have swallowing problems, because they compensate unconsciously by choosing foods that are easier to eat, or they eat more slowly. However, untreated swallowing problems raises the risk for choking or having large pieces of solid food lodge in the esophagus.

How Are Swallowing Problems Diagnosed?

If you think you have a swallowing problem, talk to your health care provider. You may get tests such as:

Cineradiography: An imaging test in which a camera is used to film internal body structures. During the test, you will be asked to swallow a barium preparation (liquid or other form that lights up under X-ray). An X-ray machine with videotaping capability will be used to view the barium preparations movement through the esophagus. This is often performed under the guidance of a speech pathologist, an expert in swallowing as well as speech.

Upper endoscopy: A flexible, narrow tube (endoscope) is passed into the esophagus and projects images of the inside of the pharynx and esophagus on a screen for evaluation.

Manometry: This test measures the timing and strength of esophageal contractions and muscular valve relaxation.

Impedance and pH test: This test can determine if acid reflux is causing a swallowing problem.

How Are Swallowing Problems Treated?

Treatment depends on the type of swallowing problem you have. Sometimes, a swallowing problem will resolve itself without treatment. On other occasions, swallowing problems can be managed easily. Complex swallowing problems may require treatment by a specialist or several specialists.


If you have a chewing or swallowing problem there are several things you can do to make eating and drinking easier and safer, including:


  • Sit upright at a 90-degree angle.
  • Tilt your head slightly forward.
  • Remain sitting upright or standing for 15 to 20 minutes after eating a meal.

Dining environment

  • Minimize distractions in the area where you eat.
  • Stay focused on the tasks of eating and drinking.
  • Do not talk with food in your mouth.

Amount and rate

  • Eat slowly.
  • Cut food into small pieces and chew it thoroughly. Chew food until it becomes liquid in your mouth before swallowing.
  • Do not try to eat more than 1/2 teaspoon of food at a time.
  • You may need to swallow two or three times per bite or sip.
  • If food or liquid catches in your throat, cough gently or clear your throat, and swallow again before taking a breath. Repeat if necessary.
  • Concentrate on swallowing frequently.

Saliva management

  • Drink plenty of fluids.
  • Periodically suck on Popsicles, ice chips or lemon ice, or drink lemon-flavored water to increase saliva production, which will increase swallowing frequency.


Food consistency

  • Minimize or eliminate foods that are tough to chew and eat more soft foods.
  • Puree food in a blender.
  • If thin liquids cause you to cough, thicken them with a liquid thickener (your speech pathologist can recommend one for you). You can also substitute thicker liquids for thin ones, such as nectar for juice and cream soup for plain broth.
  • Crush pills and mix them with applesauce or pudding.
  • Ask your pharmacist for theirВ recommendations on which pills should not be crushed and which medications can be purchased in a liquid form.

How to identify a swallowing difficulty

Dysphagia refers to a difficulty in swallowing – it takes more effort than normal to move food from the mouth to the stomach.

Usually caused by nerve or muscle problems, dysphagia can be painful and is more common in older people and babies.

Although the medical term “dysphagia” is often regarded as a symptom or sign, it is sometimes used to describe a condition in its own right. There is a wide range of potential causes of dysphagia; if it only happens once or twice, there is probably no serious underlying problem, but, if it occurs regularly, it should be checked out by a doctor.

Because there are many reasons why dysphagia can occur, treatment depends on the underlying cause.

In this article, we will discuss the various causes of dysphagia along with symptoms, diagnosis, and potential treatments.

How to identify a swallowing difficulty

Share on Pinterest Dysphagia is more common in older adults.

A typical “swallow” involves several different muscles and nerves; it is a surprisingly complex process . Dysphagia can be caused by a difficulty anywhere in the swallowing process.

There are three general types of dysphagia:

Oral dysphagia (high dysphagia) — the problem is in the mouth, sometimes caused by tongue weakness after a stroke, difficulty chewing food, or problems transporting food from the mouth.

Pharyngeal dysphagia — the problem is in the throat. Issues in the throat are often caused by a neurological problem that affects the nerves (such as Parkinson’s disease, stroke, or amyotrophic lateral sclerosis).

Esophageal dysphagia (low dysphagia) — the problem is in the esophagus. This is usually because of a blockage or irritation. Often, a surgical procedure is required.

It is worth noting that pain when swallowing (odynophagia) is different from dysphagia, but it is possible to have both at the same time. And, globus is the sensation of something being stuck in the throat.

Possible causes of dysphagia include:

Amyotrophic lateral sclerosis — an incurable form of progressive neurodegeneration; over time, the nerves in the spine and brain progressively lose function.

Achalasia — lower esophageal muscle does not relax enough to allow food into the stomach.

Diffuse spasm — the muscles in the esophagus contract in an uncoordinated way.

Stroke — brain cells die due to lack of oxygen because blood flow is reduced. If the brain cells that control swallowing are affected, it can cause dysphagia.

Esophageal ring — a small portion of the esophagus narrows, preventing solid foods from passing through sometimes.

Eosinophilic esophagitis — severely elevated levels of eosinophils (a type of white blood cell) in the esophagus. These eosinophils grow in an uncontrolled way and attack the gastrointestinal system, leading to vomiting and difficulty with swallowing food.

Multiple sclerosis — the central nervous system is attacked by the immune system, destroying myelin, which normally protects the nerves.

Myasthenia gravis (Goldflam disease) — the muscles under voluntary control become easily tired and weak because there is a problem with how the nerves stimulate the contraction of muscles. This is an autoimmune disorder.

Parkinson’s disease and Parkinsonism syndromes — Parkinson’s disease is a gradually progressive, degenerative neurological disorder that impairs the patient’s motor skills.

Radiation — some patients who received radiation therapy (radiotherapy) to the neck and head area may have swallowing difficulties.

Cleft lip and palate — types of abnormal developments of the face due to incomplete fusing of bones in the head, resulting in gaps (clefts) in the palate and lip to nose area.

Scleroderma — a group of rare autoimmune diseases where the skin and connective tissues become tighter and harden.

Esophageal cancer — a type of cancer in the esophagus, usually related to either alcohol and smoking, or gastroesophageal reflux disease (GERD).

Esophageal stricture — a narrowing of the esophagus, it is often related to GERD.

Xerostomia (dry mouth) — there is not enough saliva to keep the mouth wet.

Dysphagia — difficulty swallowing — can turn an enjoyable meal or evening into a painful situation. Though it does not always lead to choking, it can take an object several hours to pass through the esophagus in a patient with dysphagia. There are some medications that can help with the problem, but here are a few home remedies that can help as soon as an object is stuck and a few that will help condition the throat to improve in the future. These statements have not been evaluated by a doctor, so always make sure to consult a physician before attempting treatment with home remedies.

When Something Is Stuck

The first remedy is one that Rocky Balboa might enjoy, and that is swallowing an uncooked egg yolk and white. The texture of the egg binds to the problematic food or pill and removes the obstruction. A lump of boiled rice can help if something like a fish bone is trapped in the esophagus. It can add more weight to the bone and push it downwards. Swallowing bread can accomplish the same thing. Gargling vinegar is also a good solution when the obstruction is a large item. It can even help to soften hard bone and make it easier to swallow. Try starting with the vinegar method and then follow it up with the rice or egg. Root of clematis is an herb that can be heated and mixed with vinegar and brown sugar to remove obstructions and relieve irritation as well. The Heimlich maneuver can also be used to expel food particles trapped in airways.

Helping the Throat

Several herbs have been known to help the throat during episodes with dysphagia. Licorice (Glycyrrhiza glabra) can reduce swelling and spasms and relieve pain in the gastrointestinal tract. The typical dose is 380 mg per day. Slippery elm (Ulmus fulva) is a demulcent, which means that it promotes the healing of and protects irritated tissues. The dose is 60 mg per day. Marshmallow (Althea officianalis) is also a demulcent and an emollient (a soothing substance) and can be made in a tea with 2 to 5 g of dried leaf or root in 1 cup of boiling water. Other herbs that may be helpful are valerian (Valeriana officianalis), wild yam (Dioscorea vilosca), St. John’s wort (Hypericum performatum), skullcap (Scutellaria lateriflora) and linden flowers (Tilia cordata).

Homeopathic Remedies

Here are a few homeopathic remedies that may also help. Baptesia tincotria is used if a patient has a red, inflamed and pain-free throat that can only swallow liquids. Baryta carbonica is used if the tonsils are enlarged. Carbo vegetabilis is connected to dysphagia that is accompanied by bloating and indigestion that is worse when lying down. Ignatia should be taken when there is a feeling of a lump in the throat, back spasms, coughs and after experiencing grief. Lachesis can be used when the patient does not like being touched around the throat, which includes clothing that is tight at the neck. Make sure to consult a licensed homeopathic doctor before choosing a remedy and dosing.

In this Article

  • Who Gets Esophageal Manometry?
  • How Does Manometry Work?
  • What Happens Before Manometry?
  • Can I Eat or Drink Before Manometry?
  • What Happens During Esophageal Manometry?
  • What Happens After Having Manometry?
  • Warning About Manometry

Esophageal manometry is a test used to identify swallowing problems. It measures the strength and muscle coordination of your esophagus when you swallow. The esophagus is the “food pipe” leading from the mouth to the stomach.

During the manometry test, a tube is passed through the nose, along the back of the throat, down the esophagus, and into the stomach.

Who Gets Esophageal Manometry?

The esophageal manometry test may be given to people who have the following conditions:

  • Swallowing problems
  • Heartburn or reflux
  • Chest pain

How Does Manometry Work?

Your esophagus moves food from your throat down to your stomach with a wave-like motion called peristalsis. Manometry will indicate how well the esophagus can perform peristalsis. Manometry also allows the doctor to examine the muscular valve connecting the esophagus with the stomach, called the lower esophageal sphincter, or LES. This valve relaxes to allow food and liquid to enter the stomach. It closes to prevent food and liquid from moving out of the stomach and back up the esophagus.

Abnormalities with peristalsis and LES function may cause symptoms such as swallowing difficulty, heartburn, or chest pain. Information obtained from manometry may help doctors to identify the problem. The information is also very important for anti-reflux surgery.

What Happens Before Manometry?

Before having manometry, be sure to tell your doctor if you are pregnant, have a lung or heart condition, have any other medical problems or diseases, or if you are allergic to any medications.

Also, tell your doctor about any medicines you take. There are some drugs that may interfere with esophageal manometry. These include:

  • Proton pump inhibitors such asВ Aciphex, Nexium,В Prilosec, andВ Protonix
  • H2 blockers such as Pepcid and Zantac
  • Antacids such as MaaloxВ andВ Tums
  • Calcium channel blockers such as CardizemВ andВ Procardia
  • Nitrate medications such as Isordil and nitroglycerin
  • Beta-blockers such asВ CorgardВ andВ InderalВ

Do not discontinue any medication without first consulting with your doctor.

Can I Eat or Drink Before Manometry?

Do not eat or drink anything eight hours before having manometry.

What Happens During Esophageal Manometry?

During esophageal manometry, a small (about 1/4 inch in diameter) flexible tube is passed through your nose, down your esophagus, and into your stomach. You are not sedated, although a topical anesthetic (pain-relieving medication) may be applied to your nose to make the passage of the tube more comfortable. The tube is connected to a machine that records the contractions of the esophageal muscles on a graph.


You may feel some discomfort as the tube is being placed, but this process takes only about a minute. Most people quickly adjust to the tube’s presence. The tube will not interfere with your breathing. Vomiting and coughing are possible (although rare) when the tube is being placed.

After the tube is inserted, you are asked to lie on your left side. You will be asked to swallow water at certain times during the test. A small sensor will record each time you swallow.

The tube is then slowly withdrawn. The gastroenterologist (a doctor who specializes in conditions of the gastrointestinal tract) will interpret the esophageal contractions that were recorded during the test.

The test lasts from 30 to 40 minutes.

What Happens After Having Manometry?

You may resume your normal diet and activities after having manometry. If your throat feels sore following the test, suck on lozenges or gargle with warm salt water.

Warning About Manometry

If you have any unusual symptoms or side effects following esophageal manometry, call your doctor or go to the emergency room immediately.


The National Institutes of Health.

Nicholas R. Metrus, MD, is board-certified in neurology and neuro-oncology. He currently works at the Glasser Brain Tumor Center with Atlantic Health System in Summit, New Jersey.

While swallowing is considered an effortless, reflexive action, it’s actually quite a complicated and coordinated maneuver involving many muscles and nerves.

As a result, neurological conditions characterized by damage to the brain, spinal cord or nerves can often result in difficulties swallowing, called dysphagia.

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Verywell / Joshua Seong

Neurological Causes

The most common neurological conditions associated with dysphagia include:

  • Stroke
  • Head trauma
  • Multiple sclerosis
  • Cerebral palsy
  • Dementia
  • Tumors of the brain or spinal cord
  • Cervical spine injury
  • Motor neuron disease
  • Myopathy

Depending on the specific neurological condition, a person may experience dysphagia for unique reasons. For example, with a stroke, a person may have difficulties swallowing because there may be an absent or delayed swallowing reflex, weakened throat muscles, and difficulty controlling tongue movements.  

In Parkinson’s disease, dysphagia may occur from a delayed swallow response, as well as a symptom called tongue pumping, in which a person’s tongue moves back and forth repetitively preventing food from leaving the mouth.

Symptoms and Complications

Swallowing difficulties can result in excess production of saliva, drooling, coughing or choking during eating, and even difficulty speaking or a hoarse voice. An infection of the lungs called aspiration pneumonia may also occur, as can malnutrition and dehydration.

To avoid these dysphagia-related complications, the evaluation of neurological illness often involves a formal swallowing assessment. This can help identify dysphagia before complications occur.

The American Heart Association recommends early screening for dysphagia after stroke to help reduce the risk of developing adverse health consequences, including weight loss, dehydration, malnutrition, pneumonia and overall quality of life concerns.  

Goals of Exercises

Therapies designed to improve swallowing are focused on strengthening muscles and building coordination of the nerves and muscles involved in swallowing. Exercising your swallowing muscles is the best way to improve your ability to swallow.

In addition to the exercises you may do with your speech and swallow therapist, you can also improve your swallowing function with at-home swallowing exercises.

Here are some swallowing exercises developed by dysphagia rehabilitation experts:

Shaker Exercise

This simple exercise can strengthen muscles to improve your swallowing ability.

To perform this exercise, lie flat on your back and raise your head as though you were trying to fixate your gaze on your toes. While you do this, make sure not to raise your shoulders.

It is best to do this exercise three to six times per day for at least six weeks. If you are able to successfully carry it out, then you can prolong the duration of each head lift and increase the number of repetitions.

Hyoid Lift Maneuver

This exercise will help you build swallowing muscle strength and control.

Place a few small pieces of paper (about one inch in diameter) over a blanket or a towel. Then place a straw in your mouth and suck one of the pieces of paper to its tip. Keep sucking on the straw to keep the paper attached, bring it over a cup or a similar container and stop sucking. This will release the paper into the container.

Your goal for each session is to place about five to 10 pieces of paper into the container.  

Mendelsohn Maneuver

This simple exercise is very effective at improving the swallowing reflex. It involves swallowing your own saliva. Normally, as the saliva enters the area just behind your mouth while swallowing, your Adam’s apple (the hard area about halfway down the front of your neck) moves up and then back down.

To do this exercise, keep your Adam’s apple elevated for about two to five seconds each time. In order to better understand the movement, you can keep your Adam’s apple elevated with your fingers at first.

Repeat this exercise several times per day until you are able to control your swallowing muscles without assistance from your hands.  

Effortful Swallow

The purpose of this exercise is to improve the contact and coordination between the different muscles used during the act of swallowing.

In essence, the exercise consists of swallowing. But as you do it, you must try to squeeze all of the muscles of swallowing as hard as you can. You do not need to swallow food during the exercise. Just a dry swallow will do.

Perform this exercise five to 10 times, three times per day to strengthen your muscles.  

Supraglottic Swallow

You should try this exercise without food first. As you become better at the exercise, you can try it with actual food in your mouth.

This exercise consists of three simple steps:

  • First, take a deep breath
  • Hold your breath, as you swallow
  • Cough to clear any residues of saliva or food which might have gone down past your vocal cords  

Super Supraglottic Swallow Maneuver

This exercise is just like the supraglottic maneuver described above, but with an extra twist.

After you take that deep breath, bear down while swallowing. The pressure generated helps with swallowing and increases the strength of your swallowing muscles.  

A Word From Verywell

If you or a loved one has dysphagia from a neurological cause, these exercises can improve swallowing and help prevent aspiration and malnutrition.

During swallow rehabilitation, your therapist may also recommend dietary changes to improve swallowing like using a straw or spoon, taking smaller bites of foods, or using a thickener to bulk up thin liquids.

By Arwen Jackson, M.A., CCC-SLP; Bridget Harrington, M.A., CCC-SLP; and Carol Spicer, OTR/L, Anna and John J. Sie Center for Down Syndrome, Children’s Hospital Colorado

How to identify a swallowing difficulty

It’s important to identify and treat feeding and swallowing issues early to ensure your child with Down syndrome gets the most out of every healthy meal.

Children with Down Syndrome can encounter problems with feeding or swallowing due to physical, medical, or behavioral issues associated with their condition. Low muscle tone , sensory problems, food refusal, low endurance, or issues with oral motor skill development can all lead to problems that make eating difficult. This creates stress for children and their parents and can ultimately interfere with a child’s ability to grow and thrive.

A safe and enjoyable meal begins with attending to your child’s cues and supporting where he or she is developmentally.

Both breast- and bottle-feeding help babies grow and develop oral motor skills. Beyond looking at your baby’s mouth, it is critical to observe the coordination of breathing and swallowing, the level of alertness, and beginning postural control. Babies do best with latching when they are in an awake, alert state. To help babies stay awake, talk to them, stroke their feet, or change their diapers.

A pediatrician may suggest working with specialists, such as those at the Feeding Clinic at the Anna and John J. Sie Center for Down Syndrome at Children’s Hospital Colorado, to develop a safe and effective feeding plan that can be adapted to babies who breast-feed, bottle-feed, or both.

A parent’s power of observation is crucial in detecting issues with feeding and swallowing. Look for signs of swallowing difficulties, such as red watery eyes, coughing, choking, congestion, and chronic pulmonary or respiratory illness. Any of these could indicate dysphagia, or difficulty swallowing, which requires further medical investigation.

During meals, feeding difficulties may appear as prolonged or no chewing, overstuffing the mouth, and pocketing food. Behavioral signs related to feeding issues can include, but are not limited to, food refusal, inability to sit at the table, unwillingness to try new foods, or willful gagging and vomiting.

If your child is overstuffing his or her mouth, place two or three bites of food on a plate at a time and continue offering small servings. Children often have difficulty controlling the impulse to stuff their mouths when offered a full plate of food.

Poor postural stability also affects children’s ability to sit and actively participate in feeding themselves. If they cannot hold their heads up independently or have difficulty sitting, eating safely is more challenging. To improve posture, try holding your child in a more upright position on your lap or placing small towel rolls on either side of the trunk while in a high chair. This may offer enough support to free up the child’s hands for food exploration and self-feeding.

If your child appears to have behavioral or sensory issues with food, try these tips to set him or her up for success:

  • Lay the groundwork for fun and exploration before mealtime. Let children have a voice in what they want to eat and allow them to help with meal preparation — make a smoothie together, for example. Allow them to experience the sensory side of preparing food by touching, smelling, and of course, tasting the ingredients.
  • Eat at their eye level. Children learn eating skills by watching you, so it’s important that you model these skills at their eye level.
  • Listen — even when your child isn’t saying anything. Young children with Down syndrome may take longer to chew and swallow food than typical children. Don’t rush them. Understand that nonverbal cues, such as pushing a spoon away or turning the head to the side, are your child’s way of saying, “I’m not ready for another bite yet.” Respecting these signs builds trust, which is the foundation of a successful feeding relationship.

Finally, remember that every child is different and a one-size-fits-all approach to treating feeding and swallowing challenges may not work. Pediatricians and specialists can be invaluable resources, assisting parents in developing evidence-based, individualized feeding plans to help children find mealtime success.

Feeding and swallowing challenges can follow individuals with Down syndrome into adulthood. If this happens, it’s important for friends, family, and caregivers to encourage or provide consistent, structured mealtimes.

Being attentive to adults’ feeding behaviors is important, as some people may not be able to verbalize that a problem, such as a cavity or pain when swallowing, is present. Refusal to eat, sudden shifts in food choices and nutrition level, and changes in normal feeding behavior may be clues that something is amiss.

The following resources provide additional information for parents whose children with Down syndrome have feeding and swallowing issues: