Difficulty with swallowing is affecting about 16% of polio survivors in WA. This can range from occasionally choking on saliva, food causing a bout of coughing, problems initiating swallowing eg tablets, food 'sticking' in throat, getting stuck half way down, regurgitation of food, to obstruction of airways requiring assistance to dislodge eg slap on back or Heimlich manoeuvre.

Foods most likely to cause problems include dry crumbly food like cake, peas, nuts, seeds, dry bread, crisp vegetables (eg carrot, apple), tough meat, certain cheeses, peanut butter, pop drinks.

*  Chew food slowly and well.  Concentrate on swallowing.  Avoid distractions like talking, reading, or watching TV when eating.

*  Eat the most difficult foods first while swallowing muscles are less fatigued.

*  Take small mouthfuls.  Eat small meals more frequently so muscles don't tire so quickly.

*  Take your time.  Swallow several times per mouthful and swallow all before next mouthful.

*  Alternate solids and fluids to help wash food down.  Soften, thicken or liquefy foods.

*  Fluids are easier to swallow if the chin is tucked down.  Raising the chin when swallowing allows food to drop into the airway.

*  Use a straw to swallow tablets as throwing the head back to get them to the back of the throat raises the chin increasing aspiration danger.

*  Use a straw for thin liquids like water, tea, fruit juice, cool drinks.  Thicker drinks like nectar, egg flips, purees, soups, jellies are less likely to cause problems.

*  Cool or cold water often feels more "slippery" in the mouth and is more difficult to control.  Cold constricts muscles making them less control-able as winter does to all muscles.  Warm or hotter foods and liquids are easier - relaxes swallowing muscles so they work better.  Avoid cold foods like icecream which seize up the muscles.

*  If weakness is worse on one side, turn the head to the opposite side when swallowing as this closes off the weaker side allowing the stronger muscles to complete the swallowing action.

*  Close your mouth before swallowing.  This helps to create a vacuum which helps the swallowing process.

*  Voice boxes can also be affected by weak muscles.  Don't try to talk if voice is weakening.  Allow the vocal cord muscles to rest, like other polio muscles need to.

*  Avoid foods that have seeds, nuts, crumbly bits or require lots of chewing, like  peas, cucumber, coconut, lettuce, raw carrot, steak, nuts etc.

*  Avoid problem foods or prepare so easier to swallow eg peel apple, blend carrot, combine custard with cake, puree soup, mince meat.

*  Evaluation of swallowing problems can be done by  ENT specialists and speech therapists.