Having a tracheostomy tube or “trach” inserted in your throat can make eating and swallowing more challenging. A trach is a plastic tube that is placed through a surgical opening in your neck and into your windpipe (trachea) to help you breathe. While the trach bypasses your nose, mouth and vocal cords, you can still eat by mouth once you get used to having it in place.
Overview of eating with a trach
Eating is an important part of recovery and quality of life after getting a trach. With some adjustments and precautions, many people with trachs can resume eating regular food and continue enjoying mealtimes.
Here are some key points about eating with a trach:
- Work closely with your medical team to determine when it’s safe to start eating again. This is typically once your swallowing ability has been evaluated.
- Eat soft, moist foods initially as you get used to swallowing with the trach in place. Foods like mashed potatoes, yogurt, applesauce, scrambled eggs and well-cooked vegetables are good options.
- Take small bites and chew thoroughly before swallowing. Don’t rush meals.
- Sit upright, ideally at 90 degrees, when eating to help food and liquids pass down the esophagus instead of the trachea.
- Have suction equipment handy in case you need to clear secretions during or after meals.
- Stay hydrated by drinking throughout the day. Thickened liquids are often recommended.
- Keep your trach area clean to avoid food particles entering the trachea.
- Watch for signs of possible aspiration like coughing or choking during/after eating. Let your doctor know if this happens repeatedly.
With patience and experimentation, many trach patients can eventually return to a fairly normal diet. However, some modifications may be necessary long-term if you have trouble swallowing certain foods or liquids.
Getting assessed for swallowing ability
Before you start eating, your swallowing function will need to be evaluated to make sure it’s safe. This is because the presence of the trach tube can alter your ability to swallow normally. You may undergo tests like:
- Modified barium swallow study: You swallow barium liquid while under an x-ray to visualize your swallowing mechanism.
- Fiberoptic endoscopic evaluation of swallowing (FEES): A thin, flexible instrument is passed through your nose to examine your swallowing in real time.
- Bedside swallow evaluation: A speech pathologist watches you eat different textures of food and drink to assess your swallowing ability.
These studies give your medical team important information about risks for aspiration (food/liquid entering the airway) when eating and drinking. They can determine if your swallowing function is impaired and if certain modifications or precautions are needed when you resume oral intake.
Eating and swallowing tips with a trach
Here are some helpful tips to follow when starting to eat again after getting a tracheostomy:
Start with soft, moist foods
When first transitioning back to oral eating, it’s best to start with soft, mushy foods that are easy to swallow. Some good options include:
- Oatmeal, yogurt, mashed potatoes, apple sauce
- Soup, steamed vegetables, scrambled eggs
- Cottage cheese, mashed/pureed fruits like bananas
- Pudding, ice cream, smoothies
Avoid dry, crunchy foods initially as they require more chewing and increase your choking risk. You can gradually work up to more textured foods as your swallowing improves.
Take small bites and eat slowly
Don’t overload your mouth with food. Take small bites, chew thoroughly, and swallow each bite completely before taking another. Eat at a slow, steady pace instead of rushing. This gives you more control over the swallowing process.
Remain upright while eating
Sit completely upright at a 90 degree angle when eating, or at least keep your head elevated to 30 degrees if reclining. Gravity helps direct food down your esophagus when you’re upright rather than having it fall into your trachea.
Alternate food and drink
Swallowing will be easier if you take sips of drink between bites of food to lubricate your mouth and throat. Don’t eat large amounts of dry food before washing it down. Interspacing fluids also keeps your secretions thinner.
Check food temperature
Very hot or very cold foods can make swallowing more difficult. Lukewarm or room temperature foods may be best as you are relearning to swallow after a trach placement.
Clear secretions as needed
Keep suction equipment handy when eating to clear any saliva or food residue that enters your trach. Having your trach clear and patent will allow you to swallow more easily.
Stay hydrated
Drink fluids throughout the day to stay hydrated and make secretions easier to manage. Your doctor may recommend slightly thickened liquids if you have difficulty swallowing thin liquids. Sipping water or juice between meals can help too.
Keep your trach area clean
Gently wipe around the opening of your trach tube after eating to keep it free of food debris. Practice good oral hygiene as well by brushing your teeth after meals. This prevents food particles from entering your airway.
Eat in a calm environment
Eat in a peaceful setting without distractions. Avoid talking or laughing with food in your mouth as this can cause choking. Go slowly and focus fully on your swallowing.
Position trach properly
Make sure your trach tube is positioned correctly so it doesn’t interfere with swallowing. The opening should be centered over your trachea. Ask your doctor if adjusting the tube could improve your swallowing function.
Potential problems when eating with a trach
Some potential difficulties that can arise when resuming oral intake with a tracheostomy include:
Aspiration
Aspiration means food, liquid or saliva enters the windpipe and lungs instead of the esophagus when swallowing. This can cause coughing, choking or shortness of breath during/after eating. Fever, wheezing or chest congestion could indicate aspiration pneumonia.
Food sticking
Food that doesn’t properly pass down the esophagus may get stuck above the trach opening. This is known as impaction. It causes difficulty breathing and requires prompt removal of the blockage.
Granulation tissue
Sometimes excess scar tissue called granulation tissue grows around the tracheostomy tube. This can obstruct swallowing. Your doctor can remove it surgically or with silver nitrate sticks.
Reduced taste
Bypassing your mouth, tongue and nose can diminish your sense of taste. Foods may seem more bland. Strong seasonings, spices, lemon juice or sauces can enhance flavor in your mouth.
Delayed swallow reflex
Your swallow reflex might be sluggish after tracheostomy placement, increasing aspiration risk. Taking small bites/sips and positioning upright allows more control when swallowing.
Secretions
Thick secretions can make swallowing difficult and increase risks. Stay well hydrated and use humidification to keep secretions thinner.
Weakened muscles
Being immobile and on a ventilator can weaken your swallowing muscles. Eating practice strengthens them again. Thickened liquids are easier to control if muscles are very weak.
Reduced sensation
Numbness around the throat is common after trach surgery. This can make swallowing uncoordinated. Your sensation will likely improve with time.
Alert your medical team if you experience any of these problems regularly so adjustments can be made to ensure safe, enjoyable eating.
Advancing your diet with a tracheostomy
As your swallowing improves, you can gradually advance your diet by:
- Adding more textured foods like shredded meats, cooked vegetables, cereals
- Trying harder foods like toasted bread, rice, baked chicken
- Returning to thin liquids if approved by your clinician
- Incorporating a wider variety of foods and cuisines
Go slowly and evaluate your tolerance after each change. Your clinician can provide guidelines on how quickly to progress your diet. With time, many trach patients are eventually able to eat a normal diet and resumed preferred foods.
Long-term eating considerations
Some long-term diet modifications may be necessary if swallowing problems persist with your tracheostomy. These could include:
- Continuing a soft or minced/moist diet if chewing/swallowing remains difficult
- Using thickened liquids if thin liquids cause coughing or aspiration
- Avoiding mixed consistencies (like cereal with milk) if they increase choking risk
- Eating more slowly and being careful with certain food textures
- Taking liquids through the trach tube if unable to swallow safely
Your swallowing ability will be monitored over time to determine if restrictions are still required or if your diet can be further expanded. With patience, many people can return to a relatively normal diet despite long-term tracheostomy use.
Other mealtime tips
Here are some other tips that can make eating easier and safer with a tracheostomy:
- Moisten foods with broth, sauce, gravy or condiments if they are too dry.
- Sit upright for at least 30-60 minutes after eating to avoid reflux.
- Eat smaller, more frequent meals if you fatigue easily.
- Use spices and seasonings to enhance flavors.
- Try smooth nut butters with apples or bread if chewing is difficult.
- Communicate any difficulties you experience to your medical team.
- Consider speech therapy to improve swallow coordination.
- Have a suction machine and emergency supplies available when eating.
When to seek medical help
Contact your doctor right away if you experience:
- Choking, coughing or shortness of breath while eating/drinking
- Fever, congestion or other signs of respiratory infection after meals
- Food getting stuck above your tracheostomy tube
- Uncontrolled coughing fits that won’t stop
- Difficulty breathing or signs of oxygen deprivation
- Any concern that food/liquid may have entered your lungs
Routine swallowing assessments while your trach is in place can also help identify any problems early. Report any difficulties or changes in your swallowing function to your medical team.
Conclusion
Eating by mouth is an important part of recovery after getting a tracheostomy tube placed. With some adjustments and precautions, many patients are able to resume oral eating and enjoy a fairly regular diet. Work closely with your medical providers to determine safe consistencies and get swallowing therapy if needed. Over time, most individuals can find an eating plan that provides proper nutrition and enjoyment of food despite a chronic trach.
