How to work with speech and language therapists as a dietitian

Whilst on my final placement in oncology, I spoke to many patients experiencing symptoms of chemotherapy. A common symptom was inflammation of the mouth lining, known as mucositis. When encountering my first patient with mucositis, they described intense pain when swallowing food. Leaving the consultation, I asked my supervisor if I should contact the speech and language therapist (SLT). To my surprise, they said no. It was at this point I realised I was unsure when to contact the SLT, as I had only seen notes on patients who had already been referred to the team. I had heard the words dysphagia, dysphasia and unsafe swallow, and had a lecture at university, but I was uncertain on how to apply these to the clinical setting. A deep dive into the SLT’s role and their relationship with dietitians was needed.

Dysphasia (sometimes called aphasia) – a communication disorder. This could include helping adults and children with hearing impairments, voice disorders and learning difficulties.[1] This is less likely to involve a dietitian, but in cases where patients have had a stroke, dietitians could be involved in the broader rehabilitation process.

Dysphagia – difficulty swallowing foods, liquids and possibly saliva, which if unmanaged can lead to choking, aspiration pneumonia and
malnutrition.[1]

Aspiration – food or liquid entering the airway and lungs rather than travelling down the oesophagus to the stomach.

Below are some common symptoms to look for. Some symptoms are more general and could be observed by all healthcare professionals; others are more likely to be noted from dietetic consultations.

As a dietitian, it is important to think creatively about cooking methods, ingredients and practicalities when helping patients meet their goals. However, when required, it’s up to the SLT to set the rules for us. Finding out where the SLT has placed the patient within the International Dysphagia Diet Standardisation Initiative (IDDSI) framework [2] is essential before the creative thinking begins.

As the patient’s symptoms change, it is also essential to communicate to the SLT anything you observe that you think could be useful. This could also mean other members of the multidisciplinary team (MDT) are required to get involved. As a student, seeing the MDT working together for a patient was an eye-opener. In the case of a patient under the SLT and dietitian, if both professionals feel the patient would benefit from tube feeding, for example, it would then be up to the consultant to authorise this decision. Another example is when a patient is recovering, yet struggles with independent eating (perhaps neurological challenges mean they struggle to cut their food), the occupational therapist could help with adaptive cutlery.

The SLT will likely write points for the MDT in their notes, including the safe IDDSI level and reminders to maintain mouth care and ensure the patient is awake and alert when food is served. However, it is never a bad thing to remind people outside of the SLT. During placements, I saw patients get confused with what they could and couldn’t have and sometimes didn't even have the appropriate menu by their bed - making sure they have this is key.

Another good idea is to make sure staff know the correct IDSSI level and if they are making drinks for a patient, that they know how to make them. Make sure everyone is on the same page! And remember, IDDSI food descriptors are the right ones to use. Terms such as 'pre-mashed', 'fork mashable' and 'normal diet' are older terms, so are not now used.[4]

In the hospital, food is more controlled, with the menu provided and any snacks patients have purchased and available for everyone to see. However, in the community setting it is a little trickier. Some great companies are working hard to make the best meals at each appropriate IDDSI level, but it doesn’t mean that patients will abide by their appropriate level when no one is watching. Furthermore, research has suggested that staff in the community can be unclear about how to enforce the IDDSI framework.[5] Helping where you can with the correct plan for the patient will help to keep them safe.

Mucositis is a medical condition causing mouth ulcers and inflammation to the lining of the mouth.[6] Initially, it does not cause a communication or swallowing problem where the patient is unsafe. If a patient were to experience severe mucositis and the pain causes an unsafe swallow, the SLT could then get involved.

In summary, if an SLT has assessed your patient, take note! Ask if you are uncertain whether a referral is needed and ensure you use the IDDSI framework accurately to provide the best care possible for your patient.

References

1. North Cheshire and Mersey NHS Foundation Trust - Types of communication and swallowing difficulties. Accessed 22 May 2026. https://northcheshireandmersey.nhs.uk/our-services/adult-speech-and-language-therapy-service-halton/common-conditions/

2. International Dysphagia Diet Standardisation Initiative - Complete IDDSI Framework Detailed Definitions. Accessed 22 May 2026. https://www.iddsi.org/images/Publications-Resources/DetailedDefnTestMethods/English/V2-2DetailedDefinitionsEnglishApr2026.pdf

3. National Health Service (NHS) Greater Glasgow and Clyde - Suitable Oral Nutritional Supplements (ONS) for adult patients who require thickened fluids in a hospital or homely setting - a guide for staff. Accessed 22 May 2026. https://ggcmedicines.org.uk/media/cjcnpsxp/ons-a-guide-for-staff-2211.pdf

4. International Dysphagia Diet Standardisation Initiative - Common Ground between NDD and IDDSI. Accessed 22 May 2026. https://www.iddsi.org/images/AroundTheWorld/UnitedStates/Implementation/CommonGroundBetweenNDDandIDDSI6Mar2025.pdf

5. Wu XS, Miles A, Braakhuis A. An Evaluation of Texture-Modified Diets Compliant with the International Dysphagia Diet Standardization Initiative in Aged-Care Facilities Using the Consolidated Framework for Implementation Research. Dysphagia. 2022;37(5):1314-1325. doi:10.1007/s00455-021-10393-2

6. Mucositis. nhs.uk. December 19, 2017. Accessed 22 May, 2026. https://www.nhs.uk/conditions/mucositis/