Dysphagia, nutrition and enteral feeding

Dysphagia in MND is caused by weakness and loss of co-ordination in the muscles used for swallowing.

This can affect:

• chewing and oral control
• swallowing food and fluids
• managing saliva.

Dysphagia may increase the risk of:

• aspiration
• choking
• chest infections
• weight loss and dehydration.

Symptoms are often progressive and may vary depending on the pattern of disease involvement.

Early signs may be subtle and can be missed.

You may notice:

• coughing or choking when eating or drinking
• a wet or gurgly voice after swallowing
• taking longer to eat or drink
• difficulty managing certain textures
• weight loss or reduced appetite
• fatigue during meals.

Family members or carers may notice changes before the person notices.

Dysphagia can make it more difficult to maintain adequate nutrition and hydration.

This may lead to:

• unintentional weight loss
• reduced energy levels
• dehydration
• increased risk of infection.

Eating and drinking may also become tiring or less enjoyable, which can further affect intake.

Supporting nutrition and hydration is an important part of care.

Early recognition and support are important.

• Refer to a speech and language therapist (SLT) for swallowing assessment.
• Involve dietetics to support nutrition and hydration.
• Consider food and fluid modification where appropriate.
• Monitor weight and nutritional status.
• Allow time for eating and drinking and avoid rushing.

Support should be tailored to the person’s needs and reviewed regularly as MND progresses.

Enteral feeding involves delivering nutrition directly into the stomach, usually via a gastrostomy tube. Enteral feeding may be used alongside oral intake or as the main source of nutrition. 

It may be considered where:

• swallowing becomes unsafe
• oral intake is insufficient to maintain nutrition and hydration
• eating and drinking are becoming increasingly difficult or tiring.

Introducing discussions early can help support informed decision making and reduce pressure if needs change.

• discuss enteral feeding as part of forward planning
• involve the multidisciplinary team, including SLT, dietetics and specialist services
• consider timing carefully, including respiratory status
• respect individual preferences and choices.

Decisions about enteral feeding should be guided by the person’s preferences, clinical need and overall goals of care.

You may find the following resources helpful:

Dysphagia information sheet

Dietetics and nutrition infographic

Saliva web page

Swallowing, eating and drinking information for people with MND

You can find further guidance on symptom management and support across the Management of MND section.