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Choking alert: Strategies for safe swallowing

Therapy, exercises, and changes in eating habits will help keep you safe.

choking alert- safe swallowing
Image: nyul/ iStock

It used to be so easy to munch a handful of nuts: chew, swallow, enjoy. Now, you avoid them or make sure there’s a glass of water nearby when you eat nuts or any other foods that seem to get stuck in your throat. “It’s normal to have some age-related changes with swallowing or occasional difficulty swallowing. What’s not normal is when food or liquids get into the lungs regularly,” says Semra Koymen, a speech-language pathologist at Harvard-affiliated Brigham and Women’s Hospital.

Causes and symptoms

The simple act of swallowing is really a complicated process involving many nerves and 50 pairs of muscles. They work together to help break down food, push it to the back of the throat, close the airway, and open the esophagus, sending food to the stomach. “If those muscles aren’t moving as well, or if the reflex is mistimed, food or liquids can go down the airway. The food, or bacteria in the food, can cause pneumonia when it gets into your lungs,” says Koymen.

Swallowing trouble—known as dysphagia—is often related to aging. Just like other muscles in the body, the muscles in the throat and mouth lose bulk and strength as you age. “Occasionally, you might need to swallow a few extra times because things get stuck. Chewing may be harder, which can mean you swallow bigger chunks of food that get stuck more easily. This is a gradual change that most people adapt to without realizing it,” says Koymen.

More serious dysphagia may result from stroke; neurological conditions, such as Parkinson’s disease; mouth or throat cancer; neck injury; or breathing problems. Warning signs include coughing and choking during meals, recurrent lung infections, shortness of breath when eating, and a gurgling sound in the voice.


A speech pathologist’s evaluation of dysphagia includes an exam of your mouth and tongue, consideration of your medical history and symptoms, and most likely a test in the radiology department called a video swallow study. It’s done using a fluoroscopean x-ray machine that takes moving pictures. You swallow a variety of liquids and foods mixed with barium, a substance that shows up on x-rays. “As you swallow, we can see the material move through the mouth and throat and into the esophagus,” says Koymen.


Addressing dysphagia starts with a course of speech therapy that can last days to weeks. “We’ll teach the person exercises that improve muscle movement, strength, and range of motion,” says Koymen.

For example, stick your tongue out, push it hard against a tongue depressor, and hold for five seconds. Repeat this 10 times. This is an example of a resistance exercise to improve tongue strength. Tongue strength is considered to be the main driving force to transfer food and liquid from the mouth to the throat and esophagus.

Or you could close your lips, push your tongue into your right cheek, and hold it for five seconds. Then do the same thing on the left side. Repeat this 10 times.

Strategies to use at the dining table are also key to managing dysphagia. Talk to your therapist to see if these suggestions are right for you:

  • Take small bites and chew thoroughly.

  • Don’t talk while eating.

  • Clear your throat between bites.

  • Alternate liquids and solids.

  • Tuck your chin to your chest while swallowing, to protect your airway. (This depends on the type of problem you have, and you need a therapist’s okay before trying it.)

  • Adjust the types of foods you eat (see “Avoid these foods if you have mild swallowing trouble”).

  • Use a thickening agent in drinks, which is helpful if you have a hard time swallowing liquids.

Avoid these foods if you have mild swallowing trouble

Serious swallowing challenges may require that you eat a diet of pureed food and thickened drinks only. But people with mild dysphagia may still be able to enjoy most foods. The following, however, may need to be avoided.

  • Crunchy foods: nuts, pretzels, crackers, raw vegetables.

  • Sticky foods: peanut butter, marmalade, soft candy.

  • Mixed-consistency foods: cereal with milk, chicken noodle soup, juicy fruits (such as watermelon).

Posted by: Dr.Health

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