How to safely feed the hospitalized patient
who has difficulty swallowing
Safe feeding instructions:
1. Always talk to the nurse BEFORE giving any food or drink!
2. Ask the nurse to help you make sure the patient is sitting up as straight as possible. If
it is safe, the nurse can help you to angle the bed so that the head is higher than the
feet, or put additional pillows behind the shoulders and head.
3. It is best to feed the patient when he or she is most awake. If the patient is tired but
needs to eat, try offering softer foods that don’t require much chewing. Never feed a
patient who is very sleepy.
4. Feed slowly, using small bites. Give the person time to take a second swallow if
needed. The best way to know if you are going too fast is to ask!
5. Try using a straw for liquids. This may allow for more control over the size and
timing of the sip.
6. Give sips of liquid after every 1-3 bites, all through the meal.
7. Reduce distractions during meal time. Turn off the T.V. Limit visitors during meals.
Eliminate anything that can take the focus away from eating.
8. Encourage the person not to talk with food or liquid in his/her mouth.
9. If nutritional supplements have been recommended, try to give them during the meal,
before the person gets too full. You can also give them as snacks between meals.
(Remember to ask the nurse first.) Many types of supplements are available.
10. Always look inside the patient’s mouth at the end of the meal. Before the patient lies
down, ask the nurse for help to remove any remaining food that could go down the
wrong way.
STOP FEEDING and CALL the NURSE Right Away:
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If you see the patient coughing or choking during meals. Talk to the nurse or ask
the medical team about ordering a swallowing evaluation with a specialist.
If you notice more congestion or if the patient’s voice sounds gurgly (as if it’s
“under water.”). This may be a sign that food and/or liquid is going down the wrong
way into the lungs. Some patients with swallowing problems may not cough when
food or fluid goes down the wrong way.
If the patient is falling asleep with food still in the mouth. Ask the nurse to help
you remove that food. Try to hold the meal until later in the day. If this happens often,
the medical team will need to determine if the patient can safely eat enough to meet
his or her nutritional needs and to stay hydrated.
If there is any change in condition or behavior, such as difficulty breathing,
change in color, increased mucous and/or change in the color of mucous.
If you believe that the patient is having a hard time swallowing. BIDMC has
swallowing specialists who can do an evaluation. They can give you more specific
recommendations to make eating and drinking as safe as possible. Your medical team
can arrange this evaluation if necessary.
MC1701 11/09