How to assist during meals a resident who pockets food in his cheek?

According to the National Institutes of Health, food pocketing, also known as food pouching or cheeking, is a common issue among residents with conditions like dementia or dysphagia. Learning how to assist during meals a resident who pockets food in his cheek is crucial for ensuring their safety and nutritional intake, as unmanaged pocketing can lead to complications such as aspiration pneumonia.

Quick Summary

This guide covers safe feeding techniques, dietary modifications, and strategies to address the underlying causes of food pocketing. It details how to position a resident correctly, use adaptive tools, and reduce mealtime distractions to promote safer swallowing and enhance oral awareness.

Key Points

• Modify Food Texture: Use soft, moist, and pureed foods to make swallowing easier and reduce the risk of pocketing.

• Offer Small Bites: Give small, manageable portions to prevent the resident from overwhelming their mouth with too much food at once.

• Provide Verbal Cues: Use gentle reminders like "chew" and "swallow" to help residents who forget the next step in the eating process.

• Ensure Proper Positioning: Have the resident sit upright at a 90-degree angle to aid safe swallowing and minimize aspiration risk.

• Check the Mouth After Meals: Perform an oral sweep to ensure no food remains in the cheeks, followed by thorough oral hygiene.

• Reduce Distractions: Create a calm, quiet mealtime environment by turning off televisions and other distractions.

• Seek Professional Evaluation: Consult a speech-language pathologist for a full swallowing assessment, especially if pocketing is persistent or new.

Understanding the Causes of Food Pocketing

Food pocketing, or cheeking, can stem from several underlying issues, most of which relate to impaired oral motor skills or cognitive function. Identifying the cause is the first step toward implementing effective assistance strategies.

• Oral Motor Weakness: The resident may have weak or uncoordinated muscles in their mouth and tongue, making it difficult to move food to the back of the throat and swallow.
• Sensory Issues: Some residents may be under-sensitive to the presence of food in their mouth and are simply unaware that food remains in their cheek.
• Cognitive Decline: For individuals with dementia, the cognitive process of remembering to chew and swallow can be impaired. They may forget the next step after chewing.
• Pain or Fear: Discomfort from poorly fitting dentures, dental issues, or a fear of choking can cause a resident to hold food in their mouth to avoid swallowing.
• Dietary Aversion: The texture or temperature of certain foods may be unappealing, causing the resident to hold the food to avoid eating it.

Creating a Safe and Supportive Mealtime Environment

A calm, focused, and positive atmosphere can significantly reduce anxiety and help the resident concentrate on eating.

1. Reduce Distractions: Turn off televisions, radios, and other electronics during mealtime to minimize sensory overload.
2. Ensure Proper Positioning: Have the resident sit in an upright position (90-degree angle) with feet flat on the floor. This posture helps with swallowing and reduces the risk of aspiration.
3. Sit at Eye Level: Sitting face-to-face with the resident at eye level can improve communication and help you monitor their swallowing.
4. Use Good Lighting: Ensure the dining area is well-lit so the resident can clearly see the food on their plate.

Practical Mealtime Techniques and Aids

These hands-on strategies focus on promoting a safe and effective eating process.

• Offer Small, Manageable Bites: Use a shallow-bowled spoon to give smaller amounts of food. This prevents the resident from taking too much at once and overwhelming their oral capacity.
• Provide Gentle Verbal Cues: Gentle reminders like, "Chew that bite," or "Now let's swallow," can prompt the resident to remember the next step.
• Alternate Food and Liquid: After a few bites of solid food, offer a sip of liquid. This helps clear the mouth and encourages swallowing. Using an open cup can also help clear the mouth more effectively than a straw.
• Perform Oral Sweeps: At the end of the meal, or periodically during it, gently check the resident's cheeks with a tongue depressor or finger (if trained and safe to do so) to ensure all food is cleared. Follow up with oral care after every meal.
• Hand-Over-Hand Assistance: For residents who have difficulty moving food to their mouth, guide their hand (while they hold the utensil) to help them complete the motion. This action can help trigger the brain's eating patterns.

The Importance of Dietary Modifications

Modifying the texture of food and liquids can make swallowing easier and safer. A speech-language pathologist (SLP) is best equipped to recommend the appropriate modifications.

Comparison of Diet Modifications

Feature	Pureed Diet	Soft/Minced and Moist Diet	Regular Diet with Modifications
Consistency	Smooth, pudding-like texture with no lumps.	Minced or finely chopped, with sauces or gravy for moisture.	Modified with sauces or gravy; avoids dry, hard, or crumbly textures.
Chewing Required	Minimal to none.	Some chewing required.	Full chewing required, but with easier-to-manage foods.
Best For	Residents with significant oral motor weakness, poor awareness, or high aspiration risk.	Residents who can chew but have some swallowing difficulties.	Residents with mild difficulties who benefit from softer, moist foods.
Examples	Pureed meats, fruits, and vegetables; yogurt, pudding.	Minced chicken with gravy, well-cooked pasta with sauce, soft-cooked vegetables.	Soft bread, bananas, cheese cubes, stewed meat.

When to Seek Professional Assistance

While these strategies are effective, it is crucial to recognize when professional help is needed. A speech-language pathologist specializes in evaluating and treating swallowing disorders (dysphagia). They can provide a comprehensive assessment and recommend specific interventions like swallowing exercises. Consult a doctor if pocketing is a new behavior or if the resident shows signs of distress, weight loss, or potential aspiration, such as coughing or a gurgling voice after swallowing.

Conclusion

Effectively assisting a resident who pockets food in their cheek involves a multi-faceted approach. By understanding the potential causes, creating a calm and supportive environment, and implementing hands-on techniques like offering small bites and verbal cues, caregivers can significantly reduce the risks associated with food pocketing. Dietary modifications, guided by a healthcare professional, are also vital for enhancing safety and enjoyment. Regular monitoring and proactive oral care complete a comprehensive strategy designed to protect the resident's health and dignity during mealtime.

Frequently Asked Questions

What is the primary danger of a resident pocketing food?

The primary danger of food pocketing is the risk of aspiration, where food enters the lungs instead of the stomach, potentially causing aspiration pneumonia.

What are some common reasons why a resident might pocket food?

Common reasons for food pocketing include weak oral muscles, sensory issues that cause a lack of awareness of food in the mouth, cognitive decline (such as with dementia), fear of choking, or disliking certain food textures.

How can I check if a resident has food pocketed in their cheek?

You can check by gently asking the resident to open their mouth and perform a visual scan. A trained caregiver can also use a tongue depressor or finger sweep (if appropriate) to clear any remaining food.

Should I rush a resident who is eating slowly and pocketing food?

No, you should never rush a resident. Allowing ample time to chew and swallow each bite is crucial. A fast pace increases the risk of choking and anxiety.

What types of food should be avoided if a resident is pocketing food?

Avoid dry, sticky, or hard-to-chew foods like tough meat, bacon, or dry bread. Foods with mixed textures, such as soup with bits or crumbly biscuits, can also be challenging.

What is the purpose of alternating bites with sips of liquid?

Alternating sips of liquid with bites of food helps clear the oral cavity of any remaining food particles, ensuring a cleaner mouth and promoting a more complete swallow.

When should a caregiver contact a professional about a resident's pocketing behavior?

A caregiver should contact a doctor or speech-language pathologist if food pocketing is a new behavior, occurs frequently, or is accompanied by signs of distress, weight loss, or possible aspiration, such as coughing or a gurgling voice.