Why Do People With Strokes Sometimes Need Their Liquids Thickened?

My Aunt had a stroke and now we have to add something called "Thick-it" to all her liquids.  How does this help her swallow?  Janet W.

Dear Janet,

Sometimes after a person has a stroke, or if they have any condition that affects their gag reflex (ALS, Parkinsons Disease, advanced stages of Alzheimers), liquids will not be swallowed properly, but instead will accidentally go down the windpipe (trachea) instead of the food pipe (esophagus).  We can experience something like this if we are talking while we eat, or accidentally take a breath while we drink: We cough and cough and say, "something went down the wrong way".  But in stroke patients where the swallow reflex is affected, the person may not even sense that something did go down into the lungs, and may not have a coughing reflex to attempt to get the fluids out.  Eventually, this can lead to a build up of fluid in the lungs and lead to pneumonia, advance to a serious infection, and even result in death.

Thick-It is a powdered thickener that, when added in varying amounts, can make liquids the consistency of honey, nectar, or pudding.  The prescription from the doctor will usually specify to what thickness liquids should be made.

Thickening all liquids (even water) will make it easier for the nervous system to sense what is in the back of the throat (fluids are not as easy to sense), close the epiglottis (the flap that covers the trachea when swallowing) and send the liquids down the safe, intended route to the stomach.

The swallowing process is not done consciously, so if the swallowing function is not working properly , a person may present to the hospital with frequent episodes of pneumonia without knowing the cause. In order to diagnose the condition a speech therapist will do a swallow assessment with the patient, and if any signs of aspiration (food or fluids going down the trachea) are suspected, the next step would be a modified barium swallow (x-ray test) to see exactly what is going on in the throat during swallowing.