A person might have dysphagia (swallowing difficulty) if they show one or more of these signs, especially if they occur repeatedly or worsen over time:

During eating or drinking

• Coughing or choking while swallowing
• Gurgly, wet, or hoarse voice after swallowing
• Food or liquid leaking from the mouth
• Needing to swallow multiple times to clear one bite or sip
• Pain when swallowing (odynophagia)
• Feeling of food stuck in the throat or chest

After eating or drinking

• Frequent throat clearing
• Shortness of breath
• Unexplained weight loss or dehydration
• Recurring chest infections or pneumonia (from aspiration)

Observation clues

• Avoiding certain foods or textures
• Taking much longer than normal to finish meals
• Fatigue during eating
• Unusual facial expressions or grimacing while swallowing

If these signs are noticed, especially in elderly people, stroke survivors, or those with neurological conditions, a medical evaluation is needed.
Diagnosis is usually confirmed by a speech-language pathologist or doctor using tests such as a clinical swallow evaluation, videofluoroscopic swallow study (VFSS), or fiberoptic endoscopic evaluation of swallowing (FEES).

To know the thickness levels for dysphagia, you can follow the IDDSI (International Dysphagia Diet Standardisation Initiative) framework.
It classifies liquids from Level 0 (thin) to Level 4 (extremely thick) and uses simple tests to measure them. Read more here

Main Testing Method – IDDSI Flow Test

1. Use a 10 ml syringe (standard catheter-tip).
2. Block the nozzle with a finger and fill to exactly 10 ml.
3. Release finger and let liquid flow out for exactly 10 seconds.
4. Measure how much liquid is left in the syringe and compare to the table above.

Extra tip:
For home checks without a syringe, IDDSI also has the spoon tilt test (for Level 4 foods) and fork drip test (for thick liquids and purées). They’re not as precise but still help in a pinch.

If you’ve been diagnosed with dysphagia, what you need will depend on the type and severity of your swallowing difficulty, but most people benefit from a combination of:

Professional Support

• Speech-language pathologist (SLP) – designs a safe eating/drinking plan and teaches swallowing techniques.
• Dietitian – ensures you get enough calories, protein, and fluids despite texture changes.
• Doctor – treats underlying conditions (e.g., neurological, reflux, muscle weakness).

Safe Food & Drink Preparation

• Follow IDDSI texture levels for foods and liquids recommended by your SLP.
• Use thickening powders or pre-thickened drinks for liquids.
• Modify foods by blending, mashing, or chopping to the right texture.
• Avoid mixed textures (e.g., soup with chunks, cereal with milk) unless approved.

Adaptive Eating & Drinking Equipment

• Specialty cups (e.g., nosey cup, dysphagia cup, controlled slow flow cup).
• Special spoons (shallow bowl, soft edge).
• Non-slip placemats and plate guards if motor skills are affected.
• Straws only if approved by your SLP (can be risky for some).

Eating Environment & Habits

• Sit fully upright (90°) during and 30+ minutes after meals.
• Take small bites/sips and swallow before taking the next.
• Eliminate distractions so you can focus on swallowing.
• Eat slowly — fatigue can make swallowing less safe.

Emergency Awareness

• Know the signs of choking and aspiration.
• Caregivers should know Heimlich maneuver and when to call emergency services.

IDDSI stand for International Dysphagia Diet Standardisation Initiative.

It’s a global framework that standardizes terminology and definitions for texture-modified foods and thickened liquids to improve safety and consistency in caring for people with swallowing difficulties (dysphagia). It is categorized under a breakdown of the IDDSI levels (0–7). Read more here 

IDDSI levels are split into 2 groups: first is for liquids and the second is for food. Read more on how to test the levels at home

Liquids Level 0-4

• Level 0 – Thin
  Examples: water, coffee, tea, broth.
• Level 1 – Slightly Thick
  Examples: formula, breast milk, some pediatric thickeners.
• Level 2 – Mildly Thick (Nectar-like)
  Examples: nectar juices, smoothies, buttermilk.
• Level 3 – Moderately Thick (Honey-like)
  Examples: honey-thick drinks, thick milkshakes.
• Level 4 – Extremely Thick (Pudding-like)
  Examples: pudding, thick custard, pureed fruit.

Foods

• Level 3 – Liquidised
  Examples: blended soups, runny purees.
• Level 4 – Pureed
  Examples: mashed potato, smooth purees.
• Level 5 – Minced & Moist
  Examples: finely minced meats with sauce, mashed banana.
• Level 6 – Soft & Bite-Sized
  Examples: tender cooked vegetables, soft casseroles.
• Level 7 – Regular / Easy to Chew

Dysphagia can be caused by neurological conditions such as stroke, progressive conditions (such as Parkinson’s disease and dementia), and these conditions have specific connections:

Age

Muscle deteriorates as we get older, making us more susceptible to injury. The risk of developing many neurological conditions associated with dysphagia increases with age.

Stroke

Aspiration risk from dysphagia increases with central and peripheral neurologic disease. Stroke, microvascular ischemic disease, a spectrum of neurodegenerative diseases, and advancing dementia all have unique aspects.

Parkinson’s Disease:

Patients with neurodegenerative diseases such as Parkinson’s disease and dementia, may develop dysphagia, since it is a common diagnosis for each group in Parkinson’s patients.

Dementia:

People with Lewybody dementia tend to be more likely to have swallowing dysfunction (90%) compared to Alzheimer’s disease. They have high levels of pharyngeal dysfunction and aspirate around 45% of the time. 

Yes, cancer treatments frequently cause dysphagia. Radiation-induced dysphagia is common in patients with head and neck cancer (HNC). The radiation damages tissues in the mouth, throat, and esophagus, leading to scarring, dryness, and muscle weakness that interferes with safe swallowing.

While aging naturally affects swallowing muscles, significant dysphagia in elderly people is usually related to underlying conditions. However, dysphagia among individuals with dementia is the result of age-related changes to sensory and motor functions, in addition to those produced by the neural disease itself. 

Available evidence suggests that exercise therapy prior to oncological treatment could potentially improve swallowing process and quality of mealtimes. Common exercises for someone with dysphagia include:

• Tongue strengthening exercises (pressing tongue against roof of mouth)
• Range of motion exercises for jaw, tongue, and throat
• Swallowing practice with saliva or small sips of water
• Throat clearing and coughing exercises
• Breathing coordination exercises

Dysphagia can be cured depending on the underlying cause and whether the condition is temporary or permanent. Recovery varies significantly based on what’s causing the swallowing difficulty:

• Stroke-related: Often improves with therapy and time
• Cancer treatment: A swallow preservation protocol appears to help maintain or improve swallow function in head and neck cancer patients undergoing RT or CRT
• Progressive diseases: Usually managed rather than cured
• Structural issues: May be surgically correctable

Many people achieve safe swallowing with proper treatment, even if not completely “cured.”

Proper positioning is crucial for safe swallowing and can significantly reduce the risk of choking or aspiration during meals. Here are some ways you can do to ensure the safety during meal times:

• Ask the dysphagia patient to sit fully upright (90°) during meals and for 30+ minutes after eating
• Keep head in neutral position (not tilted back)
• Feet flat on floor for stability
• Use supportive seating if needed
• Ensure good lighting and minimal distractions

Choking prevention at home involves both safe eating practices and emergency preparedness. Here are key strategies to reduce choking risk:

• Take small bites and sips, swallowing completely before the next
• Eat slowly – fatigue makes swallowing less safe
• Eliminate distractions so you can focus on swallowing
• Follow your prescribed texture modifications (IDDSI levels)
• Avoid mixed textures unless approved by your speech therapist
• Keep emergency contacts readily available
• Ensure caregivers know the Heimlich maneuver
• Have suction equipment available if recommended

Seek immediate medical attention or take someone to the nearby hospitals whenever one or more of these conditions happen:

• Choking episodes that don’t resolve quickly
• Signs of aspiration: persistent coughing, fever, chest pain, difficulty breathing
• Complete inability to swallow liquids or saliva
• Blue lips or face (sign of oxygen deprivation)
• Recurring pneumonia or chest infections
• Severe dehydration or rapid weight loss
• High fever with breathing difficulties

Safe foods depend on your prescribed IDDSI level, however usually someone with dysphagia needs foods/drinks on these IDDSI levels:

• Level 3 (Liquidised): Smooth, pourable textures like blended soups
• Level 4 (Pureed): Smooth purees, thick custard consistency
• Level 5 (Minced & Moist): Finely chopped foods with sauce, mashed banana

Note that thickened liquids and liquidized foods level 3 and 4 have the same texture and consistency. Learn more about the difference between them on this guide. 

Thickening liquids properly is essential for safe swallowing and requires careful attention to consistency and timing. Here are the steps to ensure liquids reach the right thickness:

• Use commercial thickening powders or pre-thickened beverages
• Follow manufacturer’s instructions for mixing ratios
• Allow full thickening time (usually 2-5 minutes)
• Stir thoroughly to avoid lumps
• Test consistency before serving
• Don’t over-thicken – follow prescribed IDDSI levels
• Some medications may require liquid forms to be thickened

IDDSI Flow Test (most accurate):

• Use 10ml syringe with catheter tip
• Block nozzle with finger, fill to exactly 10ml
• Release finger, let flow for exactly 10 seconds
• Measure remaining liquid and compare to IDDSI chart

Alternative home tests:

• Spoon tilt test: For Level 4 foods – should stay on tilted spoon
• Fork drip test: For thick liquids – should drip slowly between fork tines

These home tests aren’t as precise but help check consistency between meals. You can also read more details on how to do an IDDSI flow test using syringe from this guide. 

Coffee and tea are thin liquids (Level 0) and may not be safe for many people with dysphagia. However:

• These can be thickened to appropriate levels using commercial thickeners
• Pre-thickened versions may be available commercially
• Temperature should be appropriate (not too hot)

Alcohol should generally be avoided because:

• It can further impair swallowing reflexes and coordination
• It increases aspiration risk
• It may interact with medications

Always consult your speech-language pathologist before introducing any beverages, and never assume any liquid is safe without professional guidance.