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Choking as neglect

Choking happens when a bit of food or drink gets stuck in someone’s airway. Choking can be very serious and can even cause death.

What is choking?

Older people and people with learning disabilities are at much higher risk of choking. This is because they may have swallowing problems (known as dysphagia).

Sometimes, well-meaning loved ones and carers give inappropriate food and fluids to people with swallowing problems without realising how dangerous this can be.

Other people have behaviours, such as over-stuffing their mouths with food, which increase their risk of choking.

Why does choking happen?

There are two tubes at the back of our mouths. One of the tubes called the oesophagus carries food from our mouth to the stomach. The second tube is the trachea and is the opening that air passes through to get to our lungs.

When we swallow, the trachea is automatically covered by a flap called the epiglottis to protect our airway and allow food to travel to the stomach. During choking, food can enter the trachea instead of the oesophagus causing a blockage.

The trachea gets narrower as it progresses towards the lungs. If food is blocked in the smaller area of the tube, it can cause complete blockage and restrict oxygen from reaching our lungs where it is required. This can result in brain damage and even death. Appropriate action needs to be taken at the time as brain damage is irreversible.

What signs of choking can I look out for?

  • Struggling to swallow
  • Struggling to breathe when eating
  • Drooling
  • Coughing when eating
  • Eye-watering when eating or drinking
  • Eye-widening when eating or drinking
  • Voice changes after eating/drinking, loss of voice or hoarse voice

Everyone occasionally chokes on a bit of food and generally it is not serious. However, some people may regularly choke on food or drink due to problems with chewing and swallowing their food because of their disabilities. Swallowing is difficult for some people who may be unable to control food or saliva in their mouth.

Who are the people at risk of choking?

  • People with learning disabilities
  • People with neurological conditions such as brain disorders, brain damage or brain injuries (including stroke, trauma from accidents and brain infections)
  • People with dementia
  • People with mental health issues who are on certain medications called psychotropic medications

Speech and language therapists can carry out swallowing assessments to work out if it is safe for a person to swallow or not. They can also suggest appropriate recommendations to ensure that no one is put at risk and can still enjoy their food and drink by tasting them and taking them orally.

What is the link between choking and safeguarding?

Sometimes choking happens because of neglect. For example, if a person is known to have swallowing difficulties but carers do not take steps to prevent the choking, then it could be a safeguarding concern.

When this happens we may start a safeguarding enquiry; a speech and language therapist may recommend that it is only safe for a person to have food and drinks in a pureed form. If these instructions are not followed, the person may be put at risk of choking and death.

Getting professionals together in a safeguarding enquiry helps to work out what the cause of the person’s choking is and if all care was taken to prevent the person from choking. It also allows us to put in place a plan to prevent choking on other occasions.

What can be done to prevent choking?

Many cases of choking can be prevented. To prevent choking we may make a referral to a speech and language therapist for specialist advice and support on eating and drinking, arrange for dental check-ups and work with doctors to change the medication a person is taking.

We train carers (family and friend carers or staff carers depending on where the person lives) and we can also put a personalised eating and drinking care plan in place, which may include actions such as thickening all fluids.

I’m worried about someone. What should I do?

If you are worried that someone is not being looked after properly (whether in their own home, a care home or a hospital) please get in touch with our Access and Advice Service. It takes courage to speak up about poor care, but by doing so you will help to keep someone safe.

Everyone deserves to be cared for properly. Sometimes things go wrong with someone’s care and telling us is the right thing to do. You can call Islington Access and Advice Service (Adult Social Services) on 020 7527 2299 or you can email access.service@islington.gov.uk. The Minicom number is 020 7527 6475.

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