Dysphagia refers to difficulty with swallowing or an inability to swallow. Dysphagia can arise from a wide range of neurological, structural, psychological and behavioural causes.

Normal Swallowing

Swallowing is the process that moves food or drink from the mouth to the stomach. There are four stages of swallowing.

• Stage1: Preparation of food/drink in the mouth
• Stage 2: Food is propelled to the back of the mouth before swallowing
• Stage 3: Protection of the airway, and movement of the food and/or drink through the throat
• Stage 4: Movement of food and/or drink into the stomach.

Stages one and two are voluntary, stages three and four are out of a person’s control.

Where to Start:

Recognise the signs and symptoms of dysphagia

There are several signs and symptoms that are possible indicators of dysphagia. People may not experience all these factors when they have a swallowing difficulty.

1. Changes in eating patterns e.g. reluctance or refusal to eat/drink, effortful eating/drinking, lengthy meals or changes in the ability to eat certain foods
2. Wet, gurgly voice after eating or drinking
3. Frequent coughing and spluttering, gagging and/or vomiting during or after a meal
4. Weak and or poor control of the muscles of the face, mouth or tongue (e.g. low muscle tone) or poor sensation of the face, oral or throat musculature (e.g. can be reflected in mouth stuffing of food in some children)
5. Excessive drooling or dribbling
6. Becoming drowsy or fatigued during a meal
7. Weight loss and/or dehydration/constipation
8. Difficulties biting, chewing or manipulating food in the mouth frequent spillage of food from mouth
9. Pocketing of food at the sides of the mouth
10. Multiple swallows required to clear food or drink

If you are concerned, speak to the Speech and Language Pathologist (SLP) at your school.

Why?

There are increased health and safety risks involved with dysphagia. These include choking, aspiration, malnutrition, dehydration, constipation and bowel impaction. These all have the potential to be serious or even life threatening conditions if not treated.

Speech and Language Pathologists (SLPs) are responsible for the assessment and management of children who have dysphagia. This may be done in conjunction with school staff and other professionals such as medical practitioners, occupational therapists, physiotherapists, dieticians and nurses where appropriate.

Employees have a duty to students to ensure that meal management issues are undertaken with regard to their dignity, comfort and safety.

Students have the right to have their physical and nutritional needs optimised to enable readiness for learning.

What can you expect from your school?

• If you or school staff are concerned refer your child to the school Speech and Language Pathologist (SLP).
• Your child will be assessed by your school’s SLP.
• If required, your school’s SLP will write a Meal Management Plan which recommends strategies to minimise risk factors. This plan will be monitored and reviewed regularly.
• From 2020 the Department for Education, Children and Young People has adopted and implemented the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. This is a best practice guideline used internationally in health and education settings. Individual student assessment and recommendations will be provided under this framework on a case by case basis.
• Staff working with your child will receive training in supporting students with meal time difficulties, including first aid and choking training.

Tips for supporting your child:

• Communicating with your child’s teacher or principal and/or Speech and Language Pathologist about any concerns they have in relation to their eating and drinking and/or meal management.
• Contributing to the meal management plan for your child.
• Providing food and equipment in accordance with the meal management plan and ongoing consultation with the school about this.
• Communicating any changes in medications, weight, dehydration, constipation, presence of chest infections/pneumonia with your child’s teacher or principal.
• Signing the meal management plan to indicate that the plan has been agreed to.

Further information is available in the Department’s Meal Management in Schools Policy.Meal time support – printable brochure