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Swallowing Difficulties Symptoms

Signs which could indicate potential swallowing difficulties include1,2:

  • History of choking
  • Recurrent chest infections (due to food or liquid entering the respiratory tract)
  • Coughing before, during or after swallowing
  • Changing of breathing pattern of shortness of breath when eating/drinking
  • A rattling or gurgling voice (after liquids in particular). The voice may sound hoarse or ‘wet’
  • Difficulty controlling food or liquid while in the mouth
  • Regurgitating food or liquid
  • Aspiration of food or liquid
  • Unexplained weight loss
  • Prolonged meal times
  • Refusal to eat or drink
  • Dehydration
  • Patient complains of a feeling of “obstruction” when swallowing
  • Patient has a dry mouth (xerostomia)


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Some patients might not acknowledge their symptoms, perhaps through embarrassment or because of difficulties in communication, for instance following a stroke. Asking open questions may be useful in helping to identify patients with swallowing difficulties such as:

  • ‘Do you cough after drinking or eating?’
  • ‘Do you feel that tablets / capsules stick in your throat or chest?’
  • ‘How long does it take you to eat?’
  • ‘Does your mouth feel particularly dry’

The carer could be asked whether the patient:

  • Appears to have difficulty swallowing the tablet or capsule
  • Misses taking medication because of swallowing difficulties
  • Sometimes hides medication instead of taking it
  • Needs to suck or chew tablets to make them easier to swallow

Guidelines for healthcare professionals state that you should always ask a patient about swallowing difficulties before prescribing a medicine and assess the reasons for this. This should be taken into consideration when prescribing medication.3

View References

1. https://www.medicalnewstoday.com/articles/177473 (accessed 15th March 2020) | 2. Wright et al. 2011. Prescribing Medicines for Patients with Dysphagia. A handbook for healthcare professionals | 3. Wright D, Chapman N, Foundling-Miah M et al. Consensus guideline on the medication management of adults with swallowing difficulties. In: Foord-Kelcey G, editor. Guidelines – summarising clinical guidelines for primary care. 30th ed. Berkhamsted: Medendium Group Publishing Ltd; October 2006.

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