Speech, saliva and swallowing
Swallowing difficulty
Food, drink or tablets becoming harder or slower to swallow, which can make eating tiring and sometimes less safe.
The clinical word for this is .
Still being checked
What this is
Swallowing uses the same muscles as speaking and clearing saliva, so changes often arrive together. It usually starts as meals taking longer or feeling tiring, rather than as anything dramatic. A speech pathologist is the person who assesses it, and most of what helps is practical: what you eat, how you sit, and how much time you give it.
What people often describe
- Meals taking much longer than they used to
- Coughing, or a wet-sounding voice, during or after eating
- Food feeling like it catches, or needing a drink to wash things down
- Getting tired partway through a meal and stopping before you have eaten enough
- Tablets being harder to get down than food
Important distinctions
Saliva that is hard to clear and food that is hard to swallow depend on the same muscles and are usually assessed together, but they are managed differently.
Secretions that are hard to shift can make meals harder without swallowing itself having changed much. It is worth saying which one you notice.
What may help
This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.
Practical and self-management
Things people do themselves, or with whoever is helping them.
Allied health
What a therapist can assess, teach or adjust.
Procedures
Things done in a clinical setting, usually after a referral.
When to get this looked at sooner
Tell your team if coughing at meals is becoming frequent, if your voice is often wet after eating, or if you develop signs of a chest infection. A chest infection in someone with swallowing or breathing changes is worth getting checked promptly.
Who may help
Where Compass explains this
Questions
- How can swallowing change in ALS/MND?
- What can help me eat and drink more safely and comfortably?
- What is a swallowing assessment, and what does it involve?
- What should I ask my team about swallowing?
Cards
Related
Other problems
Words explained
About this page
This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.
Evidence for this page
The sources behind the statements on this page, and where to find them. Compass does not decide which option is right for anyone.
Statement 1 of 5. Smaller mouthfuls, a slower pace, sitting upright and staying upright afterwards. Everyday changes a speech pathologist can work through with you.
Supports this. Eating and ALS — Your ALS Guide · Practical guide
A practical guide for people living with ALS describes one technique for thin liquids, and says it may solve the problem.
“If you find yourself choking on thin liquids like water, tucking your chin while taking one sip at a time may solve the problem.”
ALS Food Safety and ModificationLink checked August 2026
Statement 2 of 5. The assessment that works out what is happening and what will help. NICE says to arrange one as soon as swallowing problems are suspected, rather than waiting.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE tells teams to arrange a clinical swallowing assessment as soon as swallowing problems are suspected.
“Arrange for a clinical swallowing assessment if swallowing problems are suspected.”
1.11.4Link checked August 2026
Statement 3 of 5. Softer, moister foods and, where a speech pathologist advises it, changes to how thick drinks are. This is decided with them rather than worked out alone.
Qualifies this. Adult Dysphagia (Practice Portal) — American Speech-Language-Hearing Association · Organisation
Thickening drinks is not automatically safer. A speech pathologist decides whether it is right for you.
“In some cases, more viscous materials (i.e., thickened liquids) may be more likely to be silently aspirated (e.g., Miles et al., 2018).”
Diet Texture ModificationsLink checked August 2026
Statement 4 of 5. A tube that delivers food and fluid directly to the stomach. NICE says to discuss it early and at regular intervals, so it is a conversation rather than a crisis decision. Whether you can keep eating and drinking alongside it is worked out with your speech pathologist.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE says gastrostomy should be discussed at an early stage and revisited regularly, weighing swallowing, weight, breathing, the effort of eating and the risk of choking.
“Discuss gastrostomy at an early stage, and at regular intervals as MND progresses, taking into account the person's preferences and issues, such as ability to swallow, weight loss, respiratory function, effort of feeding and drinking and risk of choking.”
1.11.6Link checked August 2026
Statement 5 of 5. Tell your team if coughing at meals is becoming frequent, if your voice is often wet after eating, or if you develop signs of a chest infection. A chest infection in someone with swallowing or breathing changes is worth getting checked promptly.
Supports this. NICE MND guideline — NICE · Clinical guideline
Republished from the Compass answer "What are the signs that food or drink is going the wrong way, and what should I do?", where this statement is already mapped to this source.
“Treat people with MND and worsening respiratory impairment for reversible causes (for example, respiratory tract infections or secretion problems) before considering other treatments.”
1.13.1Link checked August 2026