[Dysphagia] bolus size and choking

[swlslp at yahoo.com (Sandi Lancaster)]

Hello all,

Does anyone know of general recommendations for bolus
size for solids that will not obstruct the airway in
the average adult if a bolus were to be aspirated?

I evaluated a man who is profoundly MR and the
residential staff wanted recommendations from me on
bolus size.  He does not have a history of choking or
pneumonia, but his oral stage is marked by lots of
mashing of boluses against his palate rather than
mastication, and holding of boluses before initiating
a swallow.  He had no s/s of distress with any
consistency during my evaluation.  Because this
patient presents with good tolerance of all
consistencies with his current swallowing pattern, and
doesn't have a history of choking when fed by staff, I
don't really want to recommend diet modification (why
fix what isn't broken, right?)  But the current
"action plan" for this patient is for his food to be
cut into 1/2 tsp bites.  (Which I don't think is being
done anyway.)  I would like to have staff increase
their guideline for bite size as I think 1/2 tsp is
too tiny, but I really don't know of any general rules
for what bolus sizes will or will not obstruct the
airway during an aspiration event for an adult.  

I appreciate any feedback!

Thanks,

Sandi

=====
Sandi Lancaster, M.A. CCC-SLP
Speech-Language Pathologist


		
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