Impaired Swallowing

Abnormal functioning of the swallowing mechanism associated with deficits in oral, pharyngeal, or esophageal structure or function

Defining Characteristics:

Oral phase impairment
  • Lack of tongue action to form bolus; 
  • weak suck resulting in inefficient nippling; 
  • incomplete lip closure; 
  • food pushed out of mouth; 
  • slow bolus formation; 
  • food falls from mouth; 
  • premature entry of bolus; 
  • nasal reflux; 
  • inability to clear oral cavity;
  • long meals with little consumption; 
  • coughing, choking, or gagging before a swallow; 
  • abnormality in oral phase of swallow study; 
  • piecemeal deglutition; 
  • lack of chewing; 
  • pooling in lateral sulci; 
  • sialorrhea or drooling
Pharyngeal phase impairment
  • Altered head positions; 
  • inadequate laryngeal elevation; 
  • food refusal; 
  • unexplained fevers; 
  • delayed swallow; 
  • recurrent pulmonary infections; 
  • gurgly voice quality; 
  • nasal reflux; 
  • choking, coughing, or gagging;
  • multiple swallows; 
  • abnormality in pharyngeal phase by swallowing study
Esophageal phase impairment
  • Heartburn or epigastric pain; 
  • acidic smelling breath; 
  • unexplained irritability surrounding mealtime; 
  • vomitous on pillow; 
  • repetitive swallowing or ruminating; 
  • regurgitation of gastric contents or set burps; 
  • bruxism; 
  • nighttime coughing or awakening; 
  • observed evidence of difficulty in swallowing (e.g., stasis of food in oral cavity, coughing, or choking); 
  • hyperextension of head, arching during or after meals; 
  • abnormality in esophageal phase by swallow study; 
  • odynophagia; 
  • food refusal or volume limiting; 
  • complaints of "something stuck"; 
  • hematemesis; 
  • vomiting

Related Factors:
  • Congenital deficits; 
  • upper airway anomalies; 
  • failure to thrive; 
  • protein energy malnutrition; 
  • conditions with significant hypotonia; 
  • respiratory disorders; 
  • history of tube feeding; 
  • behavioral feeding problems; 
  • self-injurious behavior; 
  • neuromuscular impairment (e.g., decreased or absent gag reflex, decreased strength or excursion of muscles involved in mastication, perceptual impairment, or facial paralysis); 
  • mechanical obstruction (e.g., edema, tracheotomy tube, or tumor); 
  • congenital heart disease; 
  • cranial nerve involvement; 
  • neurological problems; 
  • upper airway anomalies; 
  • laryngeal abnormalities; 
  • achalasia; 
  • gastroesophageal reflux disease; 
  • acquired anatomic defects; 
  • cerebral palsy;
  • internal or external traumas; tracheal, laryngeal, esophageal defects; 
  • traumatic head injury; 
  • developmental delay; 
  • nasal or nasopharyngeal cavity defects; 
  • oral cavity or oropharynx abnormalities; 
  • premature infants

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels
  • Swallowing Status
  • Swallowing Status: Esophageal Phase, Oral Phase, Pharyngeal Phase
Client Outcomes
  • Demonstrates effective swallowing without choking or coughing
  • Remains free from aspiration (e.g., lungs clear, temperature within normal range)
NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels
  • Aspiration Precautions
  • Swallowing Therapy

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