Eating and drinking with a Tracheostomy

A tracheostomy can impact your ability to eat and drink. This page provides guidance on understanding the effects of a tracheostomy on swallowing and offers strategies for effective management.

Impact on Swallowing

After a tracheostomy, you might experience some degree of swallowing difficulty due to changes in your throat and airway. While some adapt quickly and return to their usual diet, others may need to make diet changes or even require the help of a feeding tube for nutrition. Factors that can influence your ability to swallow safely include airway changes, the length of time you went without eating or drinking, muscle strength and coordination, and current health conditions. Your sense of smell and taste also may change due to breathing through your neck stoma, instead of your nose. These impacts may be even more pronounced with certain types of tracheostomy tubes such as tubes with inflated cuffs or ones that are open. Despite these obstacles, with proper assessment and support, many individuals manage to eat and drink after a tracheostomy.

Swallowing Assessment

In the hospital, a swallowing test checks if you can swallow safely, by evaluating swallowing muscle coordination and if you can protect your airway. This helps determine when you can resume eating and drinking and what types of foods and liquids are safe to consume. A speech and language therapist typically performs this test and can provide specific diet instructions and appropriate interventions to improve swallowing function based on the findings.

Special diet

You may need to follow certain swallowing techniques and diet modifications to ensure you are swallowing safely. These may include diet changes such as eating blended, moist, or soft food, drinking thickened liquids, or avoiding high-risk foods. Specific swallowing strategies can include proper positioning such as sitting upright and certain food preparation methods such as cutting food into small pieces or adding liquids. These diet modifications are tailored to meet your individual needs and are coordinated by your healthcare team, which often includes a dietician and speech language therapist.

Possible signs of swallowing problems

      • Coughing while eating or drinking
      • Choking or vomiting on food or liquids
      • Drooling when eating
      • Food/liquid coming out of tracheostomy tube
      • Change in secretions such as increased amount or seeing food particles in mucus
      • Frequent chest infections
      • Lack of appetite or interest in food
      • No reaction to food or liquids in mouth
      • Feeling anxious when eating or drinking
      • Changes in breathing during or after eating

      What to Do

      Inform your healthcare provider if any of the mentioned issues occur. If food or liquid comes out of your tracheostomy tube when swallowing or you begin coughing, pause your meal and try to cough it out or attempt to suction via your mouth and/or tracheostomy tube. Contact emergency services if you require medical help.

      Tips for Eating and Drinking

      Swallowing with a tracheostomy tube takes practice. Work closely with your healthcare team to address concerns and develop a personalized eating and drinking plan.

      Follow Diet Instructions

      Follow guidance on preparing your tube before eating such as suctioning, deflating the cuff, or applying a one-way speaking valve if instructed. Maintain swallowing precautions, diet changes, and swallowing exercises to protect yourself from food and liquid entering your airway and to ensure proper nutrition and hydration.

      Swallow Safely

      It is essential to be prepared, follow instructions, and exercise caution while eating with a tracheostomy. You may be advised to follow these measures:

      • Suction your tube and mouth before and after meals.
      • Sit upright.
      • Take smaller bites of food and sips of liquids and eat slowly.
      • Chew thoroughly.
      • Modify food texture such as pureeing food or thickening liquids.
      • Avoid high risk foods.
      • Eat smaller, more frequent meals.

      Learn more:

      References

      • Amathieu R, Sauvat S, Reynaud P, Slavov V, Luis D, Dinca A, Tual L, Bloc S, Dhonneur G. Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. Br J Anaesth. 2012 Oct;109(4):578-83.
      • Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care. 2024 Feb;79:154447.
      • National Tracheostomy Safety Project. Oral Care & Swallowing. NTSP Manual 2013 (tracheostomy.org.uk).
      • Suiter DM, McCullough GH, Powell PW. Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphagia. 2003 Fall;18(4):284-92.
      • Tsikoudas A, Barnes ML, White P. The impact of tracheostomy on the nose. Eur Arch Otorhinolaryngol. 2011 Jul;268(7):1005-8.

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