Author: aau

Disclaimer
The information in this leaflet is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified
practitioner.

L

Author = Lisa Hirst
Updated = February 2022
Review date = February 2025
Version 1.1

Department of Speech and Language Therapy
Salisbury District Hospital
Salisbury Wiltshire
SP2 8BJ
Telephone: (01722 336262 Extension: 3571
Direct Line: (01722) 345571

Unsafe swallowing

Swallowing problems (dysphagia) may result from dementia, stroke, various neurological disorders (Parkinson’s disease, multiple sclerosis, motor neurone disease, etc), learning disability and a range of other acute and chronic health conditions.
If you or your relative is experiencing swallowing difficulties, there may be a high risk of food, fluid and saliva ‘going down the wrong way’. This is when it enters the wind pipe or lungs. This is known as aspiration. Aspiration can be uncomfortable for you or your relative, although sometimes it happens with no immediate signs or symptoms (silent aspiration). Aspiration can be dangerous as it can lead to pneumonia (an infection in the lungs).
Speech and Language Therapists specialise in the assessment and treatment of dysphagia and in may cases are able to find ways to reduce the risks for people with swallowing difficulties.
However, for some patients, even with this support, their swallow is just not safe.

Alternative nutrition and hydration (ANH)

Risk feeding
(also called ‘Feeding at Risk’ or
‘Eating and Drinking with Acknowledged Risks’)

When a person continues to eat and drink despite a risk of aspiration and/or choking, this is referred to as ‘risk feeding’. Risk feeding may be put in place for one or more reasons, for example:
Advanced stages of illness
The person’s swallow is not safe and is unlikely to improve
When preferred food and drink (for quality of life) takes priority over safety
Tube feeding options are declined or inappropriate
A risk feeding decision should result in a plan which balances safety and quality of life as equally as possible, taking fully into account the personal, cultural and religious beliefs of the individual.

There are many people, who despite having an unsafe swallow, are unsuitable candidates for tube feeding or alternative nutrition and hydration for the following reasons:
The risks of long term tube feeding outweigh the benefits
Tube feeding is refused by a consenting patient
Tube feeding would not maintain or improve quality of life
It is when patients have an unsafe swallow on either food and/or drink and are not suitable for tube feeding that risk feeding should be considered.