Dysphagia secondary prevention

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Dysphagia Microchapters


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Differentiating Dysphagia from other Conditions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2],Hamid Qazi, MD, BSc [3],Feham Tariq, MD [4]


Effective measures for the secondary prevention of dysphagia include chewing your food thoroughly and eating slowly.

Secondary Prevention

  • Effective measures for the secondary prevention of dysphagia include:[1]
    • Chewing food thoroughly
    • Eating slowly
    • Swallowing therapy for stroke patients


  • Other strategies include measures taken to prevent aspiration pneumnonia as swallowing disorders include:[2][3][4]

1. Prevention of aspiration during feeding

Following strategeis help in feeding and preventing aspiration:[5]

  • 30 minute rest before feeding
  • Make the person sit upright or elevate bed-rest to 90 degree angle.
  • 'Chin-down' or' chin tuck' maneuver which is a head and neck flexion which need to be avoided in cervical injured patients[6]
  • Avoid rushing to feed or providing appropriate time in between two feeds
  • Alternate solid and liquid boluses of diet
  • Consistency suited to personal needs to patient e.g. semisolid or pureed or mechanically altered
  • Minimizing sedatives to reduce the loss of cough reflex

2. Prevention of aspiration during tube feeding

  • Bedrest elevation to 30 degree at least for continuous feed
  • Noting the signs when the patient feels nauseous, abdominal fullness or pain
  • Check for the residual volume for gastric emptying time of the patient
  • Use motility drugs if residual volume is ≥ 250 ml[5]
  • Nasogastric tube feeding is similar to percutaneous gastric tube feeding [7]

3. Prevention of aspiration during oral care

  • Care of teeth and dentures to fit properly as misfit dentures are more prone to aspiration.
  • Evidence shows that oral cleaning and hygiene in nursing home residents reduce the risk of aspiration and improves the overall quality of life.[8]


  1. Philpott, Hamish; Garg, Mayur; Tomic, Dunya; Balasubramanian, Smrithya; Sweis, Rami (2017). "Dysphagia: Thinking outside the box". World Journal of Gastroenterology. 23 (38): 6942–6951. doi:10.3748/wjg.v23.i38.6942. ISSN 1007-9327.
  2. Sue Eisenstadt E (2010). "Dysphagia and aspiration pneumonia in older adults". J Am Acad Nurse Pract. 22 (1): 17–22. doi:10.1111/j.1745-7599.2009.00470.x. PMID 20074192.
  3. Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ (1998). "Predictors of aspiration pneumonia: how important is dysphagia?". Dysphagia. 13 (2): 69–81. doi:10.1007/PL00009559. PMID 9513300.
  4. Altman KW, Yu GP, Schaefer SD (2010). "Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources". Arch. Otolaryngol. Head Neck Surg. 136 (8): 784–9. doi:10.1001/archoto.2010.129. PMID 20713754.
  5. 5.0 5.1 Bankhead, Robin; Boullata, Joseph; Brantley, Susan; Corkins, Mark; Guenter, Peggi; Krenitsky, Joseph; Lyman, Beth; Metheny, Norma A.; Mueller, Charles; Robbins, Sandra; Wessel, Jacqueline (2009). "A.S.P.E.N. Enteral Nutrition Practice Recommendations". Journal of Parenteral and Enteral Nutrition. 33 (2): 122–167. doi:10.1177/0148607108330314. ISSN 0148-6071.
  6. Terré R, Mearin F (2012). "Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study". Neurogastroenterol. Motil. 24 (5): 414–9, e206. doi:10.1111/j.1365-2982.2011.01869.x. PMID 22309385.
  7. Gomes CA, Andriolo RB, Bennett C, Lustosa SA, Matos D, Waisberg DR, Waisberg J (2015). "Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances". Cochrane Database Syst Rev (5): CD008096. doi:10.1002/14651858.CD008096.pub4. PMID 25997528.
  8. El-Solh AA (2011). "Association between pneumonia and oral care in nursing home residents". Lung. 189 (3): 173–80. doi:10.1007/s00408-011-9297-0. PMID 21533635.

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