Reducing risk and improving swallowing in a person with developmental disability

Dental or gum infections must be treated promptly to reduce the risk of the person developing respiratory illness related to dysphagia and aspiration. Recommend rigorous oral hygiene routines and 6-monthly dental review. Dentists working with people with developmental disability can advise on the person’s optimal oral care; see also Oral and dental health in people with developmental disability.

Allied health interventions to improve swallowing and reduce the risk of choking and aspiration pneumonia include:

• modifying food and fluid textures according to the International Dysphagia Diet Standardisation Initiative (IDDSI) (ie soft and bite-sized, minced and moist, puree foods; extremely thick, moderately thick, mildly thick fluids)
• providing mealtime supports and resources (eg additional support workers, specialised utensils, customised seating to help the person stay upright)
• training for all support people on techniques to prepare food and help the person eat, assisting with oral hygiene, providing appropriate levels of supervision during eating and drinking, and monitoring to ensure practices are implemented
• altering food quantities and meal timing, or pacing of oral intake
• teaching the person specific swallowing techniques to protect the airway (eg cough, swallow again, chin down)
• behavioural interventions to minimise mealtime distractions, stress and poor eating habits
• oral motor therapy from a speech pathologist to improve movements of the mouth, lips, tongue and cheeks for eating and drinking.