Following a stroke, if a patient shows coughing during swallowing, what is the appropriate next step?

• A. Continue feeding
• B. Stop feeding briefly
• C. Request a swallowing assessment from a certified professional
• D. Administer cough suppressant

Answer: (C)

Coughing during swallowing after a stroke is a red flag for dysphagia and potential airway entry of food or liquid, which means the patient is at risk for aspiration. The safest next step is to arrange a swallowing assessment with a certified professional, typically a speech-language pathologist. This evaluation determines whether swallowing is safe and what modifications are needed, such as texture changes (e.g., pureed or mechanically altered diets), specific swallowing strategies, or compensatory techniques. It may also lead to instrumental tests like a videofluoroscopic swallow study or FEES to observe how the swallow works and whether material enters the airway.

Taking this approach helps prevent complications like aspiration pneumonia and ensures proper nutrition and hydration. Simply continuing to feed or stopping feeding briefly without understanding swallow safety leaves the patient at risk, and a cough suppressant does not address the underlying impairment and could mask symptoms.