Understanding Swallowing: The Hidden Side of Speech Pathology

When most people think of speech pathologists, they think of communication. They help someone speak clearly, find their words, or build social skills. But speech pathologists also play a vital role in swallowing assessment and safe eating, supporting health, independence, and dignity.

Swallowing might seem simple, but it’s actually a complex process involving many muscles and nerves working in perfect coordination. When something goes wrong, it can not only affect how we eat and drink. It can also impact our health, independence, and dignity.

Quick Guide

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How Swallowing Works

Swallowing happens in three stages:

  1. Oral stage – Food or drink is chewed and moved to the back of the mouth.
  2. Pharyngeal stage – The throat muscles and airway work together to guide food safely past the windpipe.
  3. Oesophageal stage – The food pipe (oesophagus) carries food down to the stomach.

When any of these stages don’t work properly, food or liquid may go “down the wrong way.” This can lead to coughing or choking. Small amounts may even enter the lungs, a condition known as aspiration.

What Is Dysphagia?

Dysphagia is the medical term for swallowing difficulties. It can affect how safely and comfortably someone eats, drinks, or even manages their saliva.

Some people with dysphagia may cough or choke when swallowing, while others may quietly aspirate without obvious signs. Over time, this can lead to dehydration, malnutrition, or serious lung infections.

Swallowing difficulties are more common than most people realise, especially among:

  • Older adults
  • People who have had a stroke or brain injury
  • Those living with neurological conditions like Parkinson’s disease, dementia, or motor neurone disease
  • Individuals with head and neck cancer
  • People taking certain medications that affect saliva or muscle control

Why Safe Swallowing Is Important

Safe swallowing is about much more than comfort, it’s essential for good health and quality of life.

When swallowing becomes difficult, people may:

  • Eat and drink less, leading to weight loss and dehydration
  • Develop chest infections or aspiration pneumonia
  • Avoid social meals out of fear or embarrassment

By supporting safe swallowing, we help people stay nourished. They stay hydrated, confident, and connected. This allows them to enjoy one of life’s most meaningful daily experiences.

The Hidden Impact

Eating is about more than just nutrition, it’s a social and emotional experience. When someone can no longer enjoy meals safely, they may lose confidence. They might withdraw from shared mealtimes. They could also feel anxious about choking.

For many people, this loss of independence and dignity is just as significant as the physical risks. Supporting safe swallowing means supporting a person’s right to enjoy food, connect with others, and maintain comfort and confidence.

How Speech Pathologists Help

Speech pathologists are qualified health professionals trained to assess and manage swallowing across all ages and conditions.

When someone is referred for a swallowing assessment, the speech pathologist will:

  • Take a detailed history of eating and drinking habits
  • Observe how the person eats and drinks different textures
  • Assess muscle strength and coordination in the mouth and throat
  • Consider overall posture, alertness, and breathing

Sometimes, further testing is recommended, such as:

  • Videofluoroscopic Swallow Study (VFSS): a moving X-ray that shows food and liquid travelling through the throat.
  • Fibreoptic Endoscopic Evaluation of Swallowing (FEES): a tiny camera inserted through the nose to view the swallow in real time.

From there, the speech pathologist creates a personalised plan to support safety and comfort, which may include:

  • Adjusting food and drink textures
  • Introducing pacing or positioning strategies
  • Recommending safe swallowing techniques
  • Working closely with the person, their family, and care team to make mealtimes easier and more enjoyable

Teamwork for Safer Mealtimes

Managing swallowing difficulties is rarely done alone. Speech pathologists often collaborate with:

  • Dietitians to ensure the person’s nutrition and hydration needs are met
  • Occupational therapists to help with posture, positioning, and adaptive equipment
  • GPs and nurses to monitor overall health and medication effects
  • Families and care staff to carry out safe mealtime strategies in everyday settings

This collaborative approach ensures that care is consistent, practical, and centred on the person’s needs.

Creating a Supportive Mealtime Environment

While only speech pathologists can assess swallowing, carers and support workers play an important role in promoting safe, positive mealtimes.

You can:

  • Allow plenty of time and avoid rushing meals
  • Encourage sitting upright while eating and drinking
  • Offer small mouthfuls and prompt swallowing between bites
  • Keep distractions low (like noise or television)
  • Watch for signs like coughing, throat clearing, or fatigue
  • Make mealtimes social and enjoyable 

If any acute breathing difficulty or persistent coughing occurs, seek immediate medical attention.

These simple strategies help make mealtimes safer and more comfortable for everyone.

When to Seek Help

If you notice any of the following, it’s time to seek advice from a speech pathologist:

  • Coughing or choking when eating or drinking
  • Food or drink leaking from the mouth
  • Wet or gurgly voice after swallowing
  • Needing multiple swallows per mouthful
  • Unexplained weight loss or dehydration
  • Frequent chest infections or pneumonia
  • Avoidance of certain foods or mealtimes

Any changes to food or drink should follow individual advice from a speech pathologist. They should also adhere to local IDDSI (International Dysphagia Diet Standardisation Initiative) guidelines.


Early assessment can prevent complications and restore confidence with eating and drinking.

Your Next Step

If you’ve noticed changes in a loved one’s swallowing, eating, or drinking, don’t wait to get help.

Reach out to our Speech Pathology team at Back to Basics Health Group for guidance, assessment, and support. We’ll work with you to make mealtimes safe, comfortable, and enjoyable again.

Helpful Resources

Disclaimer: This article provides general information only and is not a substitute for individual assessment or professional advice. If choking or breathing difficulty occurs, call emergency services (000 in Australia).