Spotting swallowing difficulties, aspiration risk and choking

Welsh care-home guidance advises staff to watch for signs such as difficulty chewing or controlling food in the mouth, food or fluid falling from the mouth, food remaining after a meal, difficulty initiating a swallow, coughing or choking while eating, repeated chest infections, poor appetite, unexplained weight loss, slower eating and anxiety around mealtimes. CQC also lists difficulties or discomfort at meals or drinks time, dehydration, weight loss and chest infections as warning signs.

It is also important to distinguish ongoing swallowing problems from an acute choking emergency. Ongoing swallowing difficulty often appears as repeated coughing, a wet-sounding voice, food-holding or pocketing, slow eating or recurrent chest infections. Acute choking is sudden. Resuscitation Council UK advise suspecting choking when a person is suddenly unable to speak or cough, particularly while eating. Encourage coughing first. If coughing is ineffective, give up to five back blows, then up to five abdominal thrusts. Call 999 if the obstruction is not relieved. Do not perform blind finger sweeps. Start CPR if the person becomes unresponsive. Anyone treated with abdominal thrusts or chest compressions should be reviewed by a healthcare practitioner because complications can occur.

Signs staff should notice quickly

• During meals: coughing, throat clearing, a wet voice, food left in the mouth or repeated pocketing.
• After meals: breathlessness, distress, tiredness, chestiness or recurrent chest infections.
• General change: weight loss, dehydration, refusal or fear of eating, and slower intake.
• Acute choking: sudden inability to speak or to cough effectively while eating.
• Emergency basics: follow the adult choking response and local first-aid procedure without improvising.
• After abdominal thrusts: arrange a healthcare review even if the blockage clears.

Repeated coughing at meals needs review, but sudden inability to speak or cough needs emergency action.