When to Refer for a Swallowing Assessment

For many adults, eating and drinking are simple, everyday activities. But for someone living with Parkinson’s disease, stroke, dementia, or other neurological conditions, swallowing can become difficult or unsafe. Recognising the early signs and knowing when to refer for a swallowing assessment can prevent choking, dehydration, and serious complications such as aspiration pneumonia.

What Is a Swallowing Assessment?

A swallowing assessment is carried out by a speech pathologist who specialises in assessing and treating people with dysphagia (swallowing difficulties).

The goal is to determine:

• Whether swallowing is safe and efficient

• What food and fluid textures poses less risks for choking and aspiration

• What strategies or positioning can help make mealtimes safer

The process usually includes:

• Discuss the person’s medical history and any recent changes at mealtimes

• Observe eating and drinking different food and fluid textures

• Assess oral muscle strength, coordination, and reflexes that support eating and drinking

If further information is required, the speech pathologist may recommend an instrumental swallowing assessment, such as:

• Videofluoroscopic Swallow Study (VFSS)/ modified barium swallow study (MBSS) – X-ray examination that shows how food and drink travel from the mouth to the oesophagus

• Fibreoptic Endoscopic Evaluation of Swallowing (FEES) – a small flexible camera passed through the nose to view swallowing directly

These tests help identify which stage of swallowing is affected and guide more targeted recommendations.

Signs That It’s Time to Refer

You should consider a swallowing assessment if you notice any of the following signs during or after meals:

During meals:

• Coughing, choking, or throat clearing when eating or drinking

• Wet or gurgly voice after swallowing

• Taking much longer to finish meals than usual

• Difficulty chewing or moving food around the mouth

• Needing frequent sips of fluid to “wash food down”

After meals:

• Shortness of breath, fatigue, or changes in breathing

• Recurrent chest infections or unexplained fevers

• Weight loss, dehydration, or reduced appetite

• Complain about eating and drinking being a difficult task

Early assessment is the best way to prevent complications.

Who Commonly Needs a Swallowing Assessment?

Swallowing difficulties can affect anyone, but referrals are most common for people with:

• Stroke

• Parkinson’s disease

• Dementia

• Motor neuron disease

• Head and neck cancer

• Progressive neurological conditions

• General age-related muscle weakness

Referrals are also important for aged care residents who show new or changing mealtime behaviours. For example, increased coughing, slow eating, or repeated chest infections.

What Happens After the Assessment?

After the assessment, the speech pathologist will explain the findings and provide individualised recommendations to support safe swallowing. These may include:

• Suitable food and drink textures (based on the International Dysphagia Diet Standardisation Initiative — IDDSI framework)

• Swallowing strategies to reduce risk and improve comfort

• Environmental or positioning adjustments to support safety

Mealtime Management Plan can also be provided. Mealtime management plan is a written plan that summarises the person’s swallowing recommendations, supervision needs, and strategies for carers or staff.

Ongoing reviews may also be recommended, especially for people with progressive conditions or those recovering from acute illness.

When in Doubt, Refer Early

Swallowing changes can develop gradually, and subtle signs are often missed. What might seem like “just coughing” can be an early indicator of aspiration risk.
Timely referral to a speech pathologist ensures that people can eat and drink safely, maintain nutrition and hydration, and preserve dignity at mealtimes.