Choking
Our team provides dysphagia assessments for residents who continue to show signs of oropharyngeal dysphagia despite appropriate management within the home. Before contacting us, please ensure all basic dysphagia strategies have been implemented and clearly documented.
If you are concerned about a resident’s eating and drinking, first check whether they are already known to our service and whether previous recommendations have been provided. Make sure these are being followed.
If there are no existing recommendations or current strategies are not working please follow the guidance on our website before making a referral.
Please discuss concerns with other staff to confirm whether the same difficulties have been observed, and where possible speak with the resident and their family about what they are experiencing.
Please access the sections below to help you identify the appropriate management plan before making an urgent referral.
Types of choking
Watching someone choke can be upsetting. However, one choking incident on its own does not automatically mean they need a speech and language therapy assessment.
There are two types of choking:
Mild choking
If the airway is only partly blocked, the person will usually be able to speak, cry, cough or breathe. They can often clear the blockage themselves.
Severe choking
If the airway is fully blocked, the person will not be able to speak, cry, cough or breathe. Without help they will become unconscious. This requires immediate first aid, including back blows and abdominal thrusts.
Choking scenerios
If a choking incident happens once and there are no other signs of swallowing difficulty, it is reasonable to treat this as a one‑off event.
Other signs of swallowing difficulty include repeated coughing on food or drink, wet or gurgled voice after swallowing, shortness of breath, difficulties chewing, food or drink left in the mouth, spitting out or holding food, avoiding certain textures, reduced intake or weight loss, repeated chest infections, or a sensation of food sticking in the throat.
We recommend:
- Follow the advice presented in the dysphagia e‑learning programme (Dysphagia guide).
- A referral is not needed at this time.
- To reduce risk, visit the swallowing self‑management section and focus on the advice about environmental strategies and high‑risk foods.
- Monitor the person for 2 weeks to check for any additional signs of swallowing difficulty.
If there has been repeated choking, or you have other concerns about swallowing, it may be appropriate to consider referral. Before referring, we ask you to work through the following checks.
We recommend:
- Follow the advice presented in the dysphagia e‑learning programme (Dysphagia guide).
- Check whether there is an existing care plan and that advice is being followed.
- Support safer eating and drinking:
- Make sure the mouth is clear at the end of each meal.
- If the person struggles with drinks, try an open cup first.
- Most people swallow better from an open cup, though they may need support to lift it.
- Only use spouts or straws if no other safe option is available.
- To reduce risk, follow the advice in the swallowing self‑management section.
- Call the care home advice line.
If difficulties persist despite implementing best practice and advice from calling the care home advice line, please refer this patient.
