When I get together with a group of friends, they love to hear about swallowing facts. AHH, just kidding, I just think about the swallow facts in my head and try not to annoy everyone. This weekend, I went away for a few days for a hiking and birding weekend, and at one point we sat down with a smorgasbord of snacks. I had some pepperoni sticks, but the only knife I had was a little small, so of course my head went to bite size and safe swallowing.
Piecemeal deglutition is one of those swallowing behaviors that we document in MBS reports all the time, and is often cited as a reason to use strategies like taking small bites, alternating bites and sips, or changing a diet to ground meat or soft solids. However, piecemeal deglutition can be perfectly normal. In general, with any bolus size over 20 mL (think a heaping spoonful of applesauce or a whole Lorna Doone cookie) most normal people would take an extra swallow to get it down.
As we age, there is some evidence that piecemeal deglutition becomes more prevalent in healthy normals. When completing an instrumental assessment and noticing piecemeal deglutition, we need to consider other factors before deciding whether it’s a problem in need of correction or not. For example-is the patient still consuming adequate intake or has their intake decreased and they have had weight loss? This clip is a great example: This older patient most definitely takes multiple swallows per bite. However, he had been on a regular solid (IDDSI 7) diet for quite some time, was finishing meals (took a little longer than others at his table), enjoyed eating and had no weight loss. So… if we recommended changing to puree or ground meat to avoid the piecemeal deglutition…are we really fixing something? Or just eliminating the presence of a normal swallow variant that I exhibited when eating large chunks of pepperoni?