Pharmacology Book

Nutrition

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Dysphagia Diet

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  1. See Also
    1. Swallowing Exam
  2. Indications: Dysphagia with aspiration risk
    1. Cerebrovascular Accident
    2. Dementia
  3. General Guidelines for Aspiration Pneumonia prevention
    1. Patient should sit upright (>45 degrees) for eating
    2. Place food well into mouth
    3. Encourage patient to gently cough after each swallow
    4. Patient should swallow several times after each bolus
    5. Bolus size is controversial
      1. Bolus size of 20 ml appears to be most appropriate bolus size
      2. Refutes old recommendations that each bolus should be less than one teaspoon
        1. Bolus size >20 ml is required to open the upper esophageal sphincter
        2. Impossible to assist patient with enough 5 ml boluses/day to sustain nutrition
    6. Liquid consistency is controversial
      1. Thickened liquids appear to have greater risk than benefit
      2. Refutes old recommendations of thickened liquids in most restrictive Dysphagia diets
        1. Thickened liquids do not prevent aspiration more than thin liquids
        2. Thickened liquids are more likely to result in Aspiration Pneumonia
        3. Thickened liquids cause early satiety and risk dehydration and anorexia
    7. References
      1. Logemann (2007) Protocol 201, American Speech Hearing Association Meeting Lecture
        1. http://www.dysphagassist.com/major_randomized_studies
      2. Dodds (1988) AJR Am J Roentgenol 150:1307
  4. Dysphagia Diet Level I (Most restricted)
    1. Indications
      1. Patients just beginning to eat by mouth
      2. Severe Dysphagia
        1. Unable to safely swallow chewable foods
        2. Unable to safely drink thin liquids
    2. Description
      1. Thick homogenous semiliquid textures
      2. Decreased Fiber
        1. No coarse textures, nuts, raw fruits or vegetables
      3. Medications must be crushed or liquid
        1. Mix with pureed foods
  5. Dysphagia Diet Level II
    1. Indications
      1. Moderate Dysphagia
        1. Can tolerate minimal easily chewed foods
        2. Cannot swallow thin liquids safely
    2. Description
      1. Thickened liquids with commercial thickener as needed
      2. Very thick juices and milk products
      3. Decreased fiber
        1. No coarse textures, nuts, raw fruits or vegetables
      4. Medications may need to be crushed or liquid
      5. No water
  6. Dysphagia Diet Level III
    1. Indications
      1. Difficulty chewing, manipulating or swallowing foods
      2. Patients beginning to chew
    2. Description
      1. Mechanically soft or edentulous diet
        1. No tough skins
        2. No nuts, or dry, crispy, raw, or stringy foods
        3. Meats need to be minced or cut into small pieces
      2. Liquids as tolerated
      3. Medications may need to be crushed or liquid
  7. Dysphagia Diet Level IV (Least restricted)
    1. Indications
      1. Persons chewing soft textures, swallow liquids safely
    2. Description
      1. Soft textures that do not require grinding, chopping
      2. No Nuts, no raw, crisp or deep fried foods
      3. Medications and liquids as tolerated

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