If you've helped someone with a swallowing disorder to eat, you know that it is often a difficult task for both of you. You might recall him coughing after swallowing a mouthful of food and waiting through that tense moment for him to stop and take his next breath to assure you that he is not choking.

Never consider coughing during a meal as a routine part of eating. Coughing is a defensive reflex to prevent choking. Consider it Mother Nature's alarm that there is a serious problem to be addressed immediately. Report coughing while eating to your supervisory nurse immediately for assessment.

Choking, indeed, is a very serious risk factor. Be aware of this every time you help someone with HD to eat a meal. Most people with HD develop a swallowing disorder, or "dysphagia", at some point in the course of their disease. Often the first sign is a serious unanticipated choking episode. Choking and aspiration pneumonia are not uncommon causes of death in people with HD. Individuals with swallowing problems need to have their temperature and lung sounds monitored regularly for signs of pneumonia.

Learn the Heimlich manoeuvre so you'll be prepared to respond to a choking incident. Make sure everyone who assists this person to eat is practiced in the manoeuvre. It may be reassuring to explain or demonstrate it to him if he has previously had a serious choking incident. Listen very carefully to the instructions you are given on how to help this person eat his meal. Take no shortcuts; take your time. Check for proper positioning every time you put food in his mouth. Eliminate as many possible distractions in the room as you can. Double-check the texture of the food that's been specially prepared for him. Be certain liquids are thickened!

Remember, this person may be very hungry and very tired and want to race through the meal. Take your time for safety's sake. If helping him eat takes too long or is too tiring for him, arrange to have him eat less food more often throughout the day.

Creating Masterpieces With Pureed Foods

Physicians or speech/language therapists may recommend that people with serious swallowing problems and an increased risk of choking eat a diet of puree consistency.

At home or in long-term care facilities this is typically done by placing each item of a meal into a food processor and blending it beyond recognition, except for its basic colour. As if the anxiety of choking were not enough, looking forward to a daily menu of mush that looks like commercial baby food only adds further insult to injury.

However, there is an alternative. You can plan and prepare an entire menu cycle of moulded dishes, casseroles and loaves that taste, smell and look appetizing, but are the consistency of puree.

During the holiday season, department and specialty stores sell plastic candy moulds to make lollipops or chocolates in your kitchen. Like those moulds of bunnies, Santas, and ghosts, moulds of chicken legs, pork chops, broccoli florets, pear halves, and fish filets are also available. A selection of these will make your meals much more attractive.

For example, cook a chicken, remove its meat, place it in a food processor, and blend it to puree consistency. Add bread crumbs, egg whites, or a commercially available thickening product. Then place this chicken mixture on a plastic sheet with the multiple chicken legs moulded into it and freeze it. When chicken is on the menu, pop one leg from the mould, baste it, and heat it in a convection oven. It maintains its moulded shape and your kitchen smells like you're cooking... chicken!

With gravy and garnish, it looks and smells just like the unaltered chicken the rest of the family is having for dinner. It has the consistency of a chicken pate. It looks so real, it's not uncommon for nurses' aides to return moulded food to the kitchen because it looks like kitchen staff forgot to puree it!

By planning a menu of these moulded dishes and loaves (meat loaf, for example) and casseroles (tuna casserole, for example) and paying close attention to its required consistency, you can serve this pureed cuisine as an alternative to "baby food" in a three-section plate, originally designed for infants.

Nearly every major institutional food supplier in North America distributes these moulds to long-term care facilities, hospitals and other health care settings. Depending on the size of the facility, it rarely incurs additional costs or labour hours in the dietary department to prepare these pureed foods in moulds. At home, one Saturday of cooking and moulding can produce enough moulded dishes to last many weeks.