Swallowing problems (dysphagia) are common in people with Down syndrome (DS). In our large cohort study that reviewed health data from people cared for within Advocate Health, swallowing problems were more than 6 times more common in people with DS compared to people without DS.
Some swallowing issues are "behavioral." The person many not chew adequately, may rush with eating, or may not drink fluids while eating to keep their throat moist. In those situations, encouraging the individual to slow down, chew more, put the fork (or spoon) down between bites, and take a sip of fluid between bites can be helpful. We have a video and visual aids (handout 1 and handout 2) to support people with Down syndrome to slow down the rate of eating and promote better chewing.
Some swallowing issues are physiological or anatomical in nature. The swallowing mechanism can be impaired to some degree because the normal multiple steps required for swallowing don't occur normally or there is some anatomical or physical impediment to food passing along the mouth, throat, or esophagus.
Often, these are relatively minor problems. They may be managed with the same measures as noted for the "behavioral" factors above. In addition, other measures that may help some individuals include:
- cutting the food into smaller bites,
- moistening the food (with gravy or sauces),
- using a cup that limits the amount of liquid that enters the mouth with each sip,
- using a straw (or not using a straw),
- avoiding foods that are difficult to chew, or
- drinking liquids that are a little thicker (such as nectars).
If there are still concerns about swallowing, a referral to a speech therapist may be recommended. Speech therapists are the specialists who assist individuals with swallowing problems. Susan Bertucci-Maratea, Speech Therapy, at Advocate Lutheran General Hospital, shared some thoughts about swallowing function and treatment for impaired swallowing.
"Advocate Lutheran General Hospital Speech Pathologists serve adults with dysphagia (impaired swallowing). Symptoms may include coughing or choking on food or liquids, food sticking in the throat, 'wet' or gurgly voice, extended time required to eat, difficulty chewing or swallowing, reflux, malnutrition and/or history of pneumonia."
Pneumonia due to aspirating food, liquid, or one's own saliva, called aspiration pneumonia, is one of the complications of swallowing dysfunction. In people with DS who develop Alzheimer's disease, swallowing function can become impaired and recurrent pneumonias can become a serious health problem.
For treatment and evaluation, Susan Bertucci-Maratea stated:
"We generally begin by evaluating the patient's swallowing with a video fluoroscopic swallow study (intake of barium and different food consistencies visualized by x-ray). Recommendations regarding appropriate food textures, swallowing strategies, and/or swallowing therapy are made after the swallow study."
An explanation of what happens during a video swallow study can be found in this video from University of Florida Health.
A variety of strategies can be used to improve swallowing function and/or limit complications from impaired swallowing. Additional evaluation by an otolaryngologist (ENT) or gastroenterologist may also be needed to address findings on the swallow evaluation.
Swallowing can be a significant health care problem causing a variety of symptoms and complications. Attention to healthy eating, chewing, and swallowing in daily life as well as evaluation and treatment by medical professionals may be recommended to diagnose and treat swallowing problems.