Why Some People Keep Chewing but Can’t Swallow, and What Helps: The Tongue’s Role and the Reclined Position

Written by: 増田 翼 (Registered Nurse)

When people spend more time lying down because of a stroke or dementia and their disabilities are severe, they often eat in bed. In such situations, a person may keep chewing endlessly and not swallow, even when you say, “Go ahead and swallow.” Why does this happen?

Chewing mixes food with saliva and turns it into a form that is easy to swallow. Food that has reached this form is carried to the throat, portion by portion, and swallowed with a “gulp.”

Tongue movement is important for chewing, and the tongue also plays an important role in carrying food to the back of the throat. It is common for someone to be unable to swallow because they cannot send food back to the throat.

Case: C, who was told that eating by mouth would be difficult

C, who was left with paralysis on the left side of the body after a cerebral hemorrhage, had a gastrostomy (PEG) tube placed and was discharged home. The hospital doctor had explained, “Eating by mouth will be difficult. We will place a tube in the stomach, and nutrition will be given through it.”

C had always loved drinking and eating. Because of the after-effects of the hemorrhage, C had lost the ability to speak and could not express their wishes, but C’s daughter kept wondering, “Isn’t there some way for my parent to eat?”

The daughter had once given C some pudding without telling the doctor, and C coughed violently, so the family had concluded, “So eating by mouth really isn’t possible.” When I visited the home as a visiting nurse, at the daughter’s request, I was allowed to check C’s swallowing function.

In addition to the paralysis of the arm and leg, C also had paralysis on the left side of the face and could not move it. C had lost all the back teeth, and only a few lower teeth remained.

Partly because the daughter worked in caregiving, C’s teeth were brushed very carefully, and C did not choke on saliva. When about a teaspoon of water was placed in C’s mouth, C swallowed it with a “gulp,” with no coughing.

From these observations, we found that the swallowing function itself was preserved, but the functions of chewing and of sending food to the throat were impaired.

Then, after getting the doctor’s permission, we began training with yogurt. When yogurt was placed in C’s mouth, C moved the mouth as if chewing, but held the yogurt in the mouth and could not swallow it.

So we had C eat in a reclining bed with the head end raised to 30 degrees. This time, after the yogurt was placed in the mouth and C had worked it around, C was able to swallow it.

At first, C ate yogurt only when the nurse visited, but as C gradually got better at it, we had C eat with the daughter’s help as well, which increased the opportunities to eat.

C later became able to eat yogurt even when sitting upright, but passed away from heart failure. The daughter told us how happy the family was that C could eat by mouth again: “We were told eating wasn’t possible, but I’m so glad my parent was able to eat by mouth again.”

Let gravity help with a reclined position

For people who cannot send food back to the throat, a reclined position like this is effective.

Start with a reclining angle of 30 degrees. Gravity makes it easier to send food to the throat, and this position also helps prevent aspiration, in which food enters the airway. As you gradually raise the angle toward a seated position, gravity helps less, and the person needs to send food to the throat using their own strength.

Once the person can swallow well, raise the angle gradually. People whose hands are not impaired may even become able to feed themselves.

The angle can be adjusted in chairs and wheelchairs, too

Beds have a reclining function, but adjusting the angle can be difficult when the person is sitting in a chair. Under Japan’s long-term care insurance, various types of wheelchairs can be rented, including reclining wheelchairs, whose backrest lowers, and tilt-in-space wheelchairs, in which the whole seat tilts backward.

These can be used, for example, when someone usually eats in bed but would like to enjoy meals while out, such as at a day service center.

Caution: don’t let the chin tilt up

As described above, for people who keep chewing and have trouble swallowing, changing the angle can carry food to the back of the throat so that they can swallow it.

One thing to watch out for, however, is to keep the chin from tilting upward. When the chin points up, gravity acts even more and food is sent to the throat more easily, but this has a negative effect on the swallow that follows. Try swallowing your saliva with your chin up and your neck stretched. You’ll find it very difficult.

Even if food reaches the throat, if swallowing becomes difficult, there is a risk of aspiration. Use pillows to adjust the position so that there is about one fist’s width between the chin and the chest.

If you have any concerns about positioning, we recommend consulting a nurse or a rehabilitation professional as you go.

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About the author: 増田 翼 (Registered Nurse)

This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.

This is an English translation of a column originally published in Japanese by Next Co., Ltd.

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