| Mealtime
Partners, Inc.: Providing a Bridge to Greater Independence |
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| Chin Positioning During Swallowing |
For several decades it has been known that proper posture and body alignment, including a chin-tuck being produced by correct alignment of the head, are an essential part of safe eating and drinking for those who have disabilities that impact their ability to eat. Appropriate body position can minimize the risk of aspiration and is essential for patients with a diagnosis of dysphagia to reduce their likelihood of inhaling materials into the lungs. There is no perfect position for eating and/or drinking that applies to everyone and each person’s individual needs must be addressed to establish the best position for them. However, there are some general rules to maximize safety while eating that apply for the majority of people who have dysphagia and/or who are fed.
The first steps towards a safe mealtime should be taken well before a meal. The person who is going to eat should be well rested before starting to eat. They should also have time to become calm and not be over stimulated. Tiredness and over stimulation can both lead to swallowing difficulties. Additionally, in preparation for mealtime, they should be wearing their glasses (that should be clean), and their hearing-aid and false teeth (if any of these items are needed). Being able to see, hear and chew properly greatly enhances the safety and enjoyment of mealtimes and yet these items are frequently overlooked, especially for people who are fed.
A chin-tuck is also referred to as a chin-down position. There are three commonly used techniques for a chin-tuck. The first involves head flexion that bends the cervical spine at its highest point C1 through C2. Head flexion moves the chin against the neck. The eyes will be directed downward when this position is assumed and the person will have to raise their eyes to see their mealtime partner. This type of chin-tuck is used to reduce residual particles of food pocketing in the epiglottic valleculae. The epiglottic valleculae are two depressions situated between the base of the tongue and the epiglottis, one on each side of the median glosso-epiglottic ligament. (Diverticulum of the epiglottic valleculae: Report of two cases.) Their normal function is to collect saliva prior to a swallow, and for people without swallowing difficulties, they do not collect food particles during a bolus being swallowed.
The second type of chin-tuck is created using neck flexion and is instigated by flexing the cervical spine at C4 through C6. This position is helpful for those who have poor initiation of a swallow. A compound flexion combines head and neck flexion and is helpful to avoid particles pocketing in the epiglottic valleculae and to improve swallow initiation. A compound flexion, or a variation of it, is typically what most people refer to as a chin tuck.
In addition to the chin tuck being used to improve the safety of swallowing, for those who have paralysis of part of the pharynx, due to conditions such as bulbar paralysis or stroke, head rotation is helpful in combination with a chin-tuck. The head is rotated to the weak or paralyzed side and this position expands the stronger side guiding the bolus to the healthy side of the throat.
In some cases of using a chin-tuck to help with swallowing food, the food can be put into the mouth and chewed prior to assuming a chin-tuck in anticipation of swallowing. The head is upright to receive a bite of food, the food is chewed and rotated in the mouth to form a bolus, prior to swallowing, the chin is dropped into a chin-tuck and the swallow is then initiated. This process is helpful for those who have difficulty with lip closure and keeping food in their mouth while they are chewing.
Regardless of the strategies that may be employed to facilitate the safest swallow possible, the texture of the food and liquid being consumed contributes greatly to how easy it is to swallow.
This page last updated 12-19-2018