Most of us swallow hundreds of times a day without a second thought. For people living with dysphagia, every mouthful can take real effort and carry real risk.

In this article, Speech Pathologist Samantha Koutsoukos from Activate Allied Health explains what dysphagia is, who it can affect, the signs to look out for, and how a Speech Pathologist can help make mealtimes safe and enjoyable again.

What is dysphagia?

Dysphagia simply means difficulty swallowing. Every swallow happens in three main phases, and a problem at any one of them can cause dysphagia.

1. Oral phase: chewing food and moving it around the mouth to form a ball ready to swallow. This phase is voluntary, so you control it.
2. Pharyngeal phase: the throat closes off the airway so food and drink go down the right way. This happens automatically.
3. Oesophageal phase: food travels down the food pipe (oesophagus) to the stomach. This is also automatic.

Speech Pathologists also look at what happens before the first bite, sometimes called the pre oral phase. This includes mealtime behaviours and whether a person is alert, comfortable and ready to eat.

Who can dysphagia affect?

Dysphagia can affect people of all ages, from young children to older adults. Often more than one factor is at play, and these can combine to affect someone's swallow.

• Neurological conditions: stroke, Parkinson's disease, dementia and acquired brain injury
• Developmental conditions: cerebral palsy, muscular dystrophy and some genetic conditions
• Structural changes: head and neck cancer, or narrowing of the throat or oesophagus (strictures)
• Ageing: natural changes to the swallow as we get older
• Acute illness or fatigue: being unwell or run down can make swallowing harder
• Other factors: some medications and lifestyle factors

Why dysphagia matters

Swallowing difficulties affect much more than mealtimes. Left unmanaged, dysphagia can lead to:

• Aspiration and chest infections: when food or drink "goes down the wrong way" into the airway, it can lead to aspiration pneumonia.
• Malnutrition and dehydration: when eating and drinking is hard work, people often end up having less of both.
• Reduced participation and social isolation: meals out, family dinners and celebrations can start to feel out of reach.
• Difficulty taking medications: swallowing tablets safely can become a challenge too.

Signs to watch for

During or after eating and drinking, look out for:

• Coughing or choking on food or drinks
• Clearing the throat again and again through a meal
• A "wet" or gurgly sounding voice after swallowing
• Needing several swallows for one mouthful
• Food left sitting in the mouth after swallowing
• Finding meals tiring, or taking a long time to finish

If you notice any of these signs in yourself or someone you care for, it's worth speaking with a Speech Pathologist or your GP.

How a Speech Pathologist helps

Speech Pathologists are trained to assess and manage swallowing difficulties. At Activate, the process usually follows these steps:

1. Referral: we receive and triage your referral.
2. Clinical swallowing assessment: we talk through your medical history and goals, check the lips, tongue, jaw and other structures used for swallowing, and watch you eat and drink a range of foods and drinks. We look for things like timing, effort, coughing, voice changes and fatigue, and consider your risk of aspiration and whether you're getting enough food and fluids.
3. Follow up: we contact other members of your care team and gather past reports.
4. A closer look, if needed: sometimes we need to see exactly what's happening inside the throat. We may refer you for a Videofluoroscopic Swallow Study (VFSS), a moving X-ray of the swallow, or a Fibreoptic Endoscopic Evaluation of Swallowing (FEES), where a small flexible camera passed through the nose shows the throat before and after swallowing.
5. A Mealtime Management Plan: we put together a written plan for you, your family and your support workers.

A Mealtime Management Plan can cover:

• Recommended food and drink textures, using the IDDSI levels
• Positioning during meals
• Pacing and prompting strategies
• The level of supervision needed
• Equipment such as cutlery, cups and seating
• How to take medications safely
• Foods to avoid
• Signs to stop the meal
• Who to call and when to seek medical review

The plan means everyone at the table knows exactly what to do.

The IDDSI framework: one language for food and drink textures

The International Dysphagia Diet Standardisation Initiative (IDDSI) framework is a global, evidence based standard used across all ages, settings and cultures. It sorts foods and drinks into 8 levels, from 0 to 7, each with its own number and colour, so everyone prepares meals the same way.

• Level 7: Regular / Easy to chew (foods)
• Level 6: Soft & Bite Sized (foods)
• Level 5: Minced & Moist (foods)
• Level 4: Pureed / Extremely thick (foods and drinks)
• Level 3: Liquidised / Moderately thick (foods and drinks)
• Level 2: Mildly thick (drinks)
• Level 1: Slightly thick (drinks)
• Level 0: Thin (drinks)

Your Speech Pathologist will recommend the levels that suit you, and these are written into your Mealtime Management Plan.

Worried about swallowing?

If you or someone you care for is coughing, clearing their throat or sounding "wet" when eating or drinking, our Speech Pathology team can help. We can assess swallowing, create a Mealtime Management Plan and support safe, enjoyable mealtimes.

Call Activate Allied Health on (03) 8849 9795 or visit activatealliedhealth.com.au to book an appointment.

About the author

Samantha Koutsoukos is a Speech Pathologist at Activate Allied Health and a Certified Practising member of Speech Pathology Australia. She completed her Bachelor of Applied Science and Masters of Speech Pathology at La Trobe University in 2024, and has worked across community paediatric clinics, voice clinics, specialist schools and hospitals.