The holidays are a wonderful time of year, and conjure up memories of past gatherings with family and friends. Images of warmly lit homes, crackling fires, laughter, songs and the aromas that swirl about can trigger such feelings of good will. It’s a time to come together and eat.

BUT, WHAT IF EATING IS A STRUGGLE, A BATTLE, OR EVEN NOT IN THE PICTURE AT ALL?

If a family member, whether adult or child has experienced dysphagia or is on a special diet, some considerations and preparations may need to be made in advance. There is no reason for the individual experiencing a feeding difficulty or dysphagia be excluded of the joy of holiday food gatherings along with everyone else!

DYSPHAGIA OCCURS WHEN THERE IS DIFFICULTY SWALLOWING AND CAN HAVE MANY CAUSES.

It can be seen in the young child, adolescent or adult and to treat it proper diagnostics must have occurred.  Difficulty swallowing can occur at any part of the process where food travels from the mouth to the stomach and can affect nutritional status and quality of life. Some individuals diagnosed with dysphagia may have had a neurological onset for the difficulty, while others may have had surgical alterations to the alimentary tract due to cancer. Teens are at higher risk for dysphagia secondary to traumatic brain injury secondary to motor vehicle accidents. Children born with congenital anomalies or syndromes may also experience feeding difficulties. Regardless of the cause, quality diagnostics and a supportive medical team is a must. A speech-language pathologist may be closely involved in this process, including both the diagnostic process and treatment.

Sometimes, it is necessary to alter an age-appropriate diet until the individual can resume previous function, or in the case of a child, until they can learn the motor plan to handle the age appropriate food items.  This change might include a soft diet. Individuals on a soft diet may need to avoid foods that are hard to chew and swallow, such as raw fruits, vegetables, nuts, grains, and chewy breads or meats. Dry or fried foods may be difficult to manipulate and bites could be cut to a half-inch size. Foods can be cooked or mashed. Tough skins or cooked vegetables or fruits may need to be avoided.

SOME EXAMPLES OF SOFT HOLIDAY FOODS FOR A SOFT DIET INCLUDE:

• Turkey pot pie
• Roasted sweet potato with maple butter
• Apple custard
• Baked apples without the skin

A mechanical soft diet has a bit more texture and is similar to the soft diet, yet more seasonings can be added. Meats need to be moistened with broth or gravy and ground for chopped. It may be wise to skip crunchy or difficulty to chew/swallow garnishes. Ground meats, poultry and fish all with added moisture provide good protein needs. Fruits and vegetables need to be soft-cooked or pureed. Desserts can include puddings, yogurts, custards and very moist cakes.

SOME EXAMPLES OF MECHANICAL SOFT DIET HOLIDAY FOODS MIGHT INCLUDE:

• Ham salad
• Cranberry orange relish
• Simple bread stuffing (moist, avoiding nuts, dry fruits)
• Pumpkin cheesecake layered dessert (parfait)

A pureed diet should be pureed to a pudding-like consistency. With small toddlers, there should be no obvious lumps and bumps. Course food textures are obviously avoided, and raw fruits, fruits and nuts are eliminated. Some foods may need natural or commercial thickeners to reach the proper consistency. Meats, breads, fruit, vegetables and rice can all be pureed. Mashed potatoes with gravy or butter would qualify as a pureed item. Custards, yogurts and smooth consistency puddings would also be classified as pureed.

PUREED HOLIDAY FOODS INCLUDE:

• Butternut squash soup
• Pureed biscuits and gravy
• Pureed turkey
• Mashed potatoes and gravy
• Sweet potato pie (crustless)

WHAT ABOUT THE PATIENT WHO IS TUBE FED AND CANNOT CURRENTLY EAT ANYTHING BY MOUTH?

Below are some potential suggestions that individuals with NPO (nothing passed orally) status and their families/loved ones may choose to utilize.

For the adult who may have a new onset ‘ban’ from eating, two key considerations should be kept in mind:

1. Avoid as much as possible all food references in interactions, and
2. Plan ahead how to navigate the ultimate event of meals during the holiday gatherings.

FOR THE PATIENT THAT IS NPO, THE ULTIMATE GOAL IS TO ENJOY THE HOLIDAYS WITHOUT FOOD BEING THE CONTEXT OF THE PLEASURABLE ACTIVITY OR CELEBRATION.

• Ask everyone to share their favorite things about family/family members (not favorite foods)
• Reminisce about favorite things that happened the past year (outside of the context of a sit-down meal)
• Plan structured leisure activities: board games, card games, dominoes, jig-saw puzzles
• Holiday movies (hopefully without too many food references)
• Holiday crafts: ornaments, knitting, crocheting, sewing
• Create family traditions that aren’t about food: dressing up in matching pajamas, go caroling, see Christmas lights
• Watch parades on TV
• Watch sports events on TV
• Assist in gift wrapping for other family members
• Plan a holiday “re-do” should the patient or family member progress to oral eating – this could be a nice motivator and provide the individual much-needed family support

Supporting the patient and caregivers experiencing dysphagia, regardless of age or onset,  is important for other family members to consider during the holidays. With education and acceptance, the holidays can continue to be a time of joyous celebration and unity.

Colette Ellis M.Ed., CCC-SLP, BCS-S
Speech-Language Pathologist
Board Certified Specialist in Swallowing & Swallowing Disorders
Level 4 Advanced TalkTools Therapist

REFERENCES:

Colette Ellis, M.Ed., CCC-SLP, BCS-S is a speech-language pathologist with over 38 years of clinical experience, holding Board Certification in Swallowing and Swallowing Disorders, and is a member of the TalkTools® speakers bureau. She is the owner of 29th Street Therapy Center, and the lead clinician for Grady Memorial Hospital, both in Chickasha, Oklahoma. She has recently launched a mobile FEES (fiberoptic endoscopic evaluation of swallowing) service to better serve patients and families who may not have access to specialized swallowing and voice diagnostics, (Advanced Diagnostics: Swallowing & Voice Specialists). She received her Bachelors of Science and Masters of Education in Speech-Language Pathology from the University of Central Oklahoma. Colette specializes in the evaluation and treatment of feeding, swallowing, voice, neurogenic, cognitive and oral placement disorders (OPT) of all ages. Her areas of expertise include dysphagia, voice disorders, TBI (traumatic brain injury), and OPT. Colette has specialized training in speech/oral sensory-motor/feeding therapy, aphasia, apraxia, aqua therapy, Beckman techniques, MBSImP, video-stroboscopy, and fiberoptic endoscopic evaluation of swallowing (FEES). She is fluent in French, and has been invited to speak at numerous conferences and seminars across the United States and internationally. She teaches classes on sensory-motor feeding and swallowing disorders for ASHA and AOTA CEUs.