- Safe swallowing advice: This is often the first line of management after assessment. It aims to reduce the risk of aspiration. It may include advice to: sit upright after meals to prevent residues of food in the throat going down the wrong way or not to wash food that gets stuck down with liquids but rather to encourage dry swallowing after mealtimes. This can help to clear the throat of residue rather than introducing more which can then be aspirated. Sometimes there is desensitisation to residue so a child may need reminding to dry swallow/swallow saliva after mealtimes as they can’t feel the residue there anymore. Keeping mealtimes short (20-30 mins) can help reduce the risk of muscles getting tired and food going down the wrong way.
- Food texture modification: Food consistencies can be altered to make them easier to manage eg, mashed or chopped. Sauces can be added to make things easier to swallow. Liquids can be thickened so they move more slowly through the throat and don’t go down the wrong way. There are a variety of teats, bottles, cups and straws which may make eating easier. It is best to discuss their use with your therapist to help find the best solution for a problem.
- Oral motor exercises: We are not aware of specific exercises that can strengthen the feeding muscles of children who have a muscle disease. Any exercise however will not induce harm, but it is important to monitor whether it is beneficial.
- Oral hygiene: It is helpful for everyone to regularly brush their teeth and visit a dentist for removal of plaque or treatment of cavities if required. This will help keep the mouths clean and healthy. If saliva is full of food residues or bacteria, and goes down the wrong way, a chest infection may quickly develop.
- Diet Therapy: to maintain adequate growth The aim is to prevent weight loss and maintain a suitable level of growth. There are a number of steps in treatment which you are likely to progress through until growth is satisfactory. Their use and effect on growth should be monitored regularly.
Altering the diet
This is done by increasing the frequency and amount of food eaten: eg encouraging inbetween meal snacks (i.e., eating “little and often”) and having a pudding after meals. Or by increasing the density of nutrients in the diet. For example: eating high calorie and high protein foods (eg peanut butter, fromage frais, chocolate spread) enriching foods by adding protein powders (eg skimmed milk powder) or adding fats and oils to foods (eg double cream in yoghurt, cheese in sauces).
Prescribed dietary supplements
(usually prescribed by your GP following advice from a dietitian.) These can be special fat emulsions or carbohydrate supplements which are added to high protein foods or ready-to-drink high-calorie drinks which are almost nutritionally complete. They are either fruit or milk-based, or other high calorie powders added to milk. Supplements are easy and convenient to use. They are particularly useful if eating enough food is difficult. However, there are only a limited number of flavours available and this may lead to becoming fed-up with the taste over time.