What Is a Swallow Test and When Is It Needed?

For most people, swallowing is something we do without even thinking — hundreds of times a day. But for some adults, particularly those living in aged care or with certain health conditions, swallowing can become difficult or unsafe. When this happens, a swallowing test is often recommended to check how safely food, fluids, or medication are moving through the mouth and throat.

This article explains what a swallow test is, when it’s needed, what to expect during the process, and how speech pathologists use the results to keep mealtimes safe and enjoyable.

What Is a Swallow Test?

There are two main types of swallow tests:

1. Clinical Swallow Assessment (Bedside Assessment)
   This is the most common starting point. The speech pathologist observes the person eating and drinking different textures and thicknesses, checks their posture, oral movements, and breathing patterns, and notes any signs of difficulty.

2. Instrumental Swallow Assessments
   These provide a more detailed look inside the swallowing process. The two main instrumental tests are:

• Videofluoroscopic Swallow Study (VFSS) – an X-ray video of swallowing.

• Fibreoptic Endoscopic Evaluation of Swallowing (FEES) – a small camera passed gently through the nose to view the throat.

Each type of swallow test helps determine how safely someone can eat and drink, and what modifications or strategies may be needed.

Why a Swallow Test Is Important

Swallowing difficulties (known as dysphagia) can have serious consequences if not properly managed. A swallow test helps to:

• Identify aspiration risk (food or liquid entering the airway).

• Prevent choking and chest infections.

• Guide safe food and fluid textures using the IDDSI framework.

• Support nutrition and hydration for overall health.

• Promote comfort and confidence for the person and their carers.

For aged care staff, carers, and families, understanding a person’s swallowing safety can make all the difference in preventing avoidable hospitalisations and improving quality of life.

When Is a Swallow Test Needed?

A swallow test should be requested or referred when swallowing safety is in question. Common reasons include:

• Coughing, choking, or throat clearing during or after eating or drinking.

• Wet or gurgly voice after swallowing.

• Recurrent chest infections or pneumonia.

• Weight loss, dehydration, or poor appetite.

• Difficulty chewing or controlling food in the mouth.

• Changes in swallowing following illness, stroke, or surgery.

• Behavioural changes around mealtimes — for example, refusing certain foods or taking much longer to eat.

Even mild or occasional signs should be taken seriously, as swallowing can deteriorate over time. It’s better to check early and intervene than to wait until a choking or aspiration event occurs.

Who Performs a Swallow Test?

A speech pathologist is the qualified health professional who assesses and manages swallowing difficulties. In hospitals or aged care settings, they often work closely with doctors, nurses, and dietitians to create a complete picture of the person’s mealtime safety.

After the swallow test, the speech pathologist may:

• Recommend appropriate food and fluid textures (for example, soft & bite-sized or mildly thick fluids).

• Develop a Mealtime Management Plan outlining safe swallowing strategies.

• Provide education and training for staff and family carers.

• Suggest further medical investigations if needed (e.g., ENT or dietitian review).

The results are always discussed with the person, their family, and care team to ensure everyone understands the findings and next steps.

What Happens During a Swallow Test

A swallow test is generally comfortable, non-invasive, and tailored to the person’s abilities. Here’s what typically happens:

1. Case History & Mealtime Observation
   The speech pathologist gathers information about the person’s medical history, diet, and any difficulties noticed by staff or family.

2. Oral Motor Check
   They examine how the lips, tongue, jaw, and throat muscles are working — as these are all crucial for safe swallowing.

3. Food and Drink Trial
   The person is offered small amounts of different food or drink textures while the speech pathologist observes for signs such as coughing, throat clearing, voice change, or delayed swallow.

4. Recommendations
   Based on the findings, the speech pathologist provides clear guidance on what is safe, what should be avoided, and whether further instrumental testing is needed.

5. Documentation
   A written report or Mealtime Management Plan is provided to guide carers and staff on safe feeding, positioning, and texture levels.

The focus is always on maintaining dignity, safety, and comfort throughout the process.