Crunchy toast with your favourite spread for breakfast, a big sandwich with lots of fillings for lunch, and a side of toast (yes, again) to dip into your favourite soup for dinner. Bread is a staple food in so many of our diets every single day. It is high in carbohydrates that give us energy, and let’s be honest, bread is delicious! Unfortunately, it isn’t all good when it comes to bread. For individuals with swallowing disorders and conditions, bread could be quite the nightmare, even fatal.
Bread in all it’s forms - whether that be toasted, fresh, white, multi-grain, cut up, crusts-on, crusts-off, plain or covered in a spread, can be still harmful for those with swallowing difficulties. It is extremely common for bread to be largely misunderstood and underestimated. It is often perceived by most as soft, ‘easy to eat’ or break down, and a go-to choice for many people. Unfortunately, the research and evidence, as well as what we see every day in our practice, show that this isn’t the case. Coroner’s reports indicate that bread is one of the most common foods that contribute to choking-related deaths. In the world of Speech Pathology and swallowing management, one of our favourite foods, can also be our biggest enemy!
The ‘dark side’ of our beloved bread.
Why is bread such a high choking risk?
When bread (as mentioned, in all it’s many forms listed above) is mixed with saliva, it’s texture changes significantly. It usually becomes wet, ‘sticky’ and dense. Speech Pathologists will be the first to tell you that this isn’t a good combination when it comes to managing swallowing difficulties. The bread then becomes more difficult to chew and break down in the mouth for someone who is already experiencing these difficulties with eating. As a result, people will try to swallow it as a larger piece of food, due to not having broken it down adequately. You can probably guess where this is going – as they try swallow the larger piece of food, a couple of things could then go wrong. Firstly, any food (bread, or other) that is not chewed enough can be too big for someone to swallow. It can then get lodged in the throat if it goes down the wrong pathway, leading to coughing and choking of the food as it blocks the airway.
Secondly, due to the stickiness of bread once it is mixed with saliva in the mouth, it could also stick to someone’s throat as it goes down the wrong way, again leading to choking.
What if I cut off the crusts?
We wish it was as simple as this – but unfortunately, the remainder of the bread still presents with the same issues discussed above. For people with dysphagia, most of the time it is best to avoid and/or eliminate bread completely.
Breadcrumbs?
Again, these are still best to avoid for someone experiencing swallowing challenges. This is because store-bought breadcrumbs in particular, but also home-made varieties are often too hard and crunchy for someone with dysphagia to manage.
How do I know if someone is experiencing difficulties with eating and chewing bread?
There is quite a lot to consider within this question, as swallowing difficulties can present uniquely across different people. For someone whose swallowing functioning is starting to decline, bread may be one of the first foods that they start to experience trouble with. In this case, a Speech Pathology referral is absolutely necessary.
This may look like:
Taking an extra amount of time compared to usual to try chew and break down the bread, appears ‘effortful’ to chew
Still having bread stuck in the inside of their teeth, mouth or oral cavity after trying to clear it with saliva and water
Taking multiple ‘swallows’ and attempts to get the bread to go down safely
Coughing or choking on bread – whether that be toasted or fresh
A resident/patient may request the crusts to be cut-off their bread, and staff or family should ask the question why. This is because they may be having troubles chewing or swallowing it, but do not want to explicitly say this.
Having dentures that do not fit properly, or a patient who does not want to wear their dentures at all, is likely to have trouble chewing and swallowing bread.
No bread – now what?
It isn’t all bad news! Thankfully, there are lots of other alternatives to bread, that may be better suitable for those who can no longer eat it. Please always consult with a Speech Pathologist and an Accredited Practising Dietitian before making any specific recommendations. Some other food and carbohydrate options that may be available instead include –
Rice
Potatoes – roasted, boiled or mashed
Pumpkin, sweet potato
Other soft vegetable varieties
Soups
Lentils
Oats, porridge
Of course, all of the above would need to be prepared according to the type of diet someone is on. For example, if someone is on a Minced and Moist diet, bread is not suitable, however rice with enough moisture is, as well as minced pumpkin.
For bread’s sake…
It can be extremely disappointing and frustrating to have to eliminate bread from someone’s diet. However, there are a lot of other great alternatives and meal options for someone experiencing dysphagia that can be eaten instead. Having different mealtime options, varieties of foods that meet nutritional needs, as well as enhancing quality of life can still be achieved with a bread-free diet. A Speech Pathologist and an Accredited Practising Dietitian can work alongside residents, patients, clients, family members and staff to achieve this.
If you are concerned about an aged care resident or patient’s mealtime management and swallowing, please contact our Speech Pathology team who can complete a comprehensive mealtime assessment and give their clinical recommendations to support as best as possible. We are available to see you at home, or across residential aged care settings.