Choking Prevention
What is choking?
Choking happens when a bit of food or drink gets stuck in someone’s airway. Choking can be very serious and can even cause death.
Older people and people with disabilities are at much higher risk of choking. This is because people with disabilities may have swallowing problems (known as dysphagia).
Other people have behaviours, such as over-stuffing their mouths with food or holding food in their mouths for a long time. These behaviours can increase their risk of choking.
Sometimes, well-meaning loved ones and carers give inappropriate food and fluids to people at increased risk of choking, without realising how dangerous this can be.
Why does choking happen?
There are two tubes at the back of our mouths. One carries air to our lungs (trachea) and one carries food and fluid to our stomachs (oesophagus).
When choking, food, fluid or saliva enters the trachea instead of the oesophagus - sometimes referred to as ‘going down the wrong way’. If food blocks the airway, it can stop oxygen getting into the lungs and this can result in brain damage – or even death. Appropriate action needs to be taken at the time as brain damage is irreversible.
Signs to look out for:
- Struggling to swallow
- Struggling to breathe when eating
- Drooling saliva
- Coughing when eating
- Eye-watering when eating or drinking
- Eye-widening when eating or drinking
- Voice changes after eating/drinking, loss of voice or hoarse voice
Why does choking happen?
Everyone occasionally chokes on a bit of food. Generally, it is not serious.
However, some people, because of their disabilities or medication, may easily or frequently choke on food or drink due to problems with chewing and swallowing. Swallowing is difficult for some people who may be unable to control food or saliva in their mouth. Also, they may not recognise their increased risk of choking. This can be more serious.
Older people and people with disabilities are at much higher risk of choking. This is because people with disabilities may have swallowing problems (known as dysphagia).
People at greatest risk of choking are:
- people with learning disabilities
- people with strokes, brain damage, brain injuries, brain disorders and brain infections
- people with dementia
- people with mental health issues who are on certain medications called psychotropic medications
Who can advise on choking prevention and interventions?
Speech and language therapists can carry out swallowing assessments to work out if it is safe for a person to swallow or not. They can also suggest appropriate recommendations to ensure that no one is put at risk and can still enjoy their food and drink by tasting them and taking them orally.
It is important that people working with those at greatest risk of choking:
What is the link between choking and safeguarding?
- carefully follow any advice from specialist medical professionals such as speech and language therapists
- stick to care plans
- are trained in first aid skills around what to do if someone is choking
- alert medical professionals if there is a change in someone’s eating or drinking skills, such as an increase in choking episodes.
Unfortunately, choking can cause serious health problems such as pneumonia and can even result in death.
Sometimes choking happens because of neglect. For example, if a person is known to have swallowing difficulties but carers do not take steps to prevent the choking, then it could be a safeguarding concern. A speech and language therapist may have made recommendations, for example that it is only safe for a person to have food and drinks in a pureed form. If these instructions are not followed, the person may be put at risk of choking and death.
When this happens we may start a safeguarding enquiry.
Getting professionals together in a safeguarding enquiry helps to work out what the cause of the person’s choking is. It also allows us to put in place a plan to prevent future choking and harm.
What can be done to prevent choking?
Many cases of choking can be prevented. To prevent choking we may:
- make a referral to a Speech and Language therapist for specialist advice and support on eating and drinking
- arrange for dental check-ups
- work with doctors to change the medication a person is on
- put in place a personalised eating and drinking care plan, which may include actions such as thickening all fluids or locking away food
- train carers (family and friend carers or staff carers depending on where the person lives)
- put in place a personalised eating and drinking care plan, which may include actions such as thickening all fluids, or supervised meals.
I’m worried about someone – what should I do?
If you are worried that someone is not being looked after properly (whether in their own home, a care home or a hospital) contact the Adult Social Care Access Team on 020 7527 2299 or complete an online safeguarding concern form
Everyone deserves to be cared for properly. Sometimes things go wrong with someone’s care and telling us is the right thing to do.
Downloadable documents:
Islington Caring with compassion leaflet
External links:
LeDeR factsheet on dysphagia and aspiration pneumonia 2093_DysphagiaAspirationPneumonia_PDF.pdf (bris.ac.uk)
Dysphagia – Clinical information for SLTs | RCSLT
The Belfast Health and Socia Care Trust has a number of useful posters and leaflets on choking prevention Resources | Belfast Health & Social Care Trust website (hscni.net)
