Stroke Health Center

It is common to have trouble swallowing, also called dysphagia, after a stroke. You may not be able to feel food on one or both sides of your mouth. You may have problems chewing or producing enough saliva. Or you may have other conditions that make eating difficult and increase your risk of choking.

Other things that may interfere with normal eating include:

• Problems seeing or judging where things are, especially on the side of your body affected by the stroke.
• Problems recognizing familiar objects or remembering how to do everyday things.
• Paralysis or weakness or trouble controlling movements (apraxia).
• Problems with smell, taste, or the sense of feeling.
• Depression, which can cause a loss of appetite and requires treatment.

If you have eating problems after a stroke, you will need a thorough evaluation by a speech therapist or another rehabilitation specialist. You may need special X-rays to see how you are swallowing. As you recover from a stroke, your rehabilitation team will monitor your progress. Swallowing and eating problems often improve over time, but some may last for the rest of your life. But there are many things you can do to make eating easier.

• Eat foods that are easy to chew, taste, and swallow, and avoid others that are not.
• Process foods to make them easier to swallow.
• Ask your speech pathologist, occupational therapist, or dietitian how to make liquids thicker. You may be able to add something to a thin liquid to make it easier to swallow.
• Eat foods that are not too hot or cold.
• Use special devices to help you eat.
• Use eating techniques that can help you prevent choking.

People who have trouble eating and swallowing after a stroke are at risk for:

• Not eating enough, which can lead to malnutrition. Lack of proper nutrition can delay recovery and cause other problems, such as losing too much weight.
• Not drinking enough liquids. Being dehydrated over a long period of time can cause health problems, and severe dehydration can be life-threatening.
• Breathing in food or liquids (aspiration). This can lead to infection of the lungs. Although many people who have had a stroke cough or choke when they breathe something into their airway, some people may not know that they have breathed something into their lungs.

Work with your speech therapist or other health professional to determine what help you need. The following are some tips for eating:

Prepare foods and liquids that are appetizing and easy to swallow

• Eat foods that smell good. Foods with a strong aroma and sweet or salty foods stimulate the production of saliva in your mouth. The extra saliva will help you swallow your food.
• Try drinking juice if you have trouble swallowing water. The taste of juice helps you know that liquid is in your mouth, so you are less likely to choke. But do not drink citrus juices, such as orange juice. These juices can be irritating and may have pulp, which may increase your chance of choking.
• Work with your speech therapist to see if eating foods at certain temperatures helps you swallow.
• Avoid sticky foods. Milk and most milk products, peanut butter, syrup, and bananas can be sticky and hard to swallow.
• Avoid very dry foods. Crackers, rice, popcorn, and toast may be difficult to swallow.
• Eat soft foods or finely chopped solid foods. Juice or soups may be added to solid food.
• It may be hard for you to swallow or feel thin liquids in your mouth. If so, ask your speech pathologist, occupational therapist, or dietitian how to make liquids thicker. You may be able to add something to a thin liquid to make it easier to swallow.

Use special devices to help you eat

Many people who have had a stroke have weakness on one side. If the hand or arm that you use to feed yourself is weak, you may find it hard to use a knife and fork. If you have problems reaching for food, spilling food, cutting meat, or opening containers, ask your speech therapist, occupational therapist, nurse, or doctor about special items that can make eating easier. Examples include:

• Large-handled silverware.
• Suction cups for dishes.
• Extra-long tongs.

Tips to prevent choking while eating

• When you drink, fill your glass only three-quarters full.
• Eat small bites of food. If you lack feeling on one side of your mouth, place your food on the other side.
• Clear your mouth and throat after each bite. Food may lodge in the affected side of your mouth. Remove it with your tongue or fingers.
• Allow about 30 to 40 minutes to eat so that you will not feel rushed. Also, sit up for 45 to 60 minutes after you finish eating.

Talk to your speech therapist, occupational therapist, nurse, or doctor for more information about managing your eating problems.