Which signs may indicate dysphagia in a resident during meals?

• A. Coughing or choking before, during, or after swallowing.
• B. Fever.
• C. Headache.
• D. Sneezing.

Answer: (A)

Coughing or choking around the act of swallowing is a key signal that swallowing may be unsafe. When someone has dysphagia, the pathway from mouth to esophagus isn’t coordinated well, so food or liquid can accidentally enter the airway. That triggers a protective cough to clear the airway, which may occur before swallowing as they prepare to take a bite, during the swallow, or after, as residue or liquid drips toward the airway. This pattern is a direct safety cue that aspiration risk is present and needs prompt attention—pause the meal, monitor closely, and report to the nurse so adjustments can be made, such as slower pacing, smaller bites, altered textures, or seating changes to improve safety.

Fever, headache, and sneezing aren’t specific signs of swallowing difficulty. Fever points to infection or illness, headache to pain or strain, and sneezing to an irritant reaction in the nasal passages. None of these directly indicate impaired swallowing safety during meals.