E-learning toolkit and resources for swallowing difficulties

Mouth holding (or pocketing) and spitting of food can happen for many different reasons. They do not always mean that the person is choking or that they need an urgent referral but are signs to pay attention to.

Many people who experience these difficulties may be living with dementia, reduced sensation, changes in chewing, low attention, fatigue or uncertainty about what to do with the food once it is in their mouth. Sometimes the person is overwhelmed, distracted or not enjoying the food being offered.

The aim is to understand why this might be happening and to explore simple, practical strategies you should try in the care home before considering a referral.

We recommend:

• following the advice presented in the dysphagia e‑learning programme (Dysphagia guide).

• A referral is not needed at this time.
• checking whether current care plans are appropriate and being followed.
• following the advice in our resource section particularly information about behaviours that challenge
• Please contact the care home advice line for further support.

We recommend:

• checking if there is already a care plan and recommendations in place
• following the advice presented in the dysphagia e‑learning programme (Dysphagia guide).

• to reduce risk, follow the advice in our resource section including considering avoiding high risk foods
• If the patient already has recommendations in place it may be appropriate to try changing their diet by one IDDSI level (for example, move from level 7 easy to chew to level 6 soft and bite sized).
• If the resident is coughing with drinks, try small single sips from an open cup. Most people swallow better with an open cup, though they may need more support to lift it. Only use spouts or straws when there is no alternative safe option.
• Please contact the care home advice line for further support.
• If problems are still being experienced despite using the resources available please refer to us and complete a monitoring form available in the section below.

We recommend:

• Monitor the resident yourselves to identify any signs of difficulty
• Follow the advice presented in the dysphagia e‑learning programme (Dysphagia guide).

• To reduce risk, follow the advice in our resource section
• Please contact the care home advice line for further support.
• If problems are still being experienced despite using the resources available please refer to us and complete a monitoring form available in the section below.

Scenario 1: There is no obvious eating or drinking difficulty

We recommend

• Consider if there is another cause to reduced intake. This could include someone moving towards end of life (see information about eating and drinking at end of life. Seek medical advice if required
• Do not refer to the Speech and Swallowing team
• Consider referring to the dietitians

Scenario 2: There is obvious eating and drinking difficulty

We recommend

• Follow the advice in our resource section on:
  • E-learning resource
  • Eating and Drinking Strategies
  • Managing eating and drinking behaviours that might challenge
• If difficulties persist, contact us on the care home advice line, and consider a referral if you have not been able to manage despite advice

We recommend:

• ensuring dentures are securely in place
• checking if there are any current recommendations.
• considering providing easy to chew foods (see resources).
• completing a monitoring diary (see resources)
• reviewing the guidance providing in Managing eating and drinking behaviours that might challenge

If difficulties persist alongside other concerns about swallowing, contact us on the care home advice line, and consider a referral if you have not been able to manage despite implementing best practice and advice.