Difficulty Eating: Causes and What Helps

Types of eating difficulty

Pinning down what makes eating hard narrows the cause quickly.

Causes of difficulty eating

Mouth, teeth and jaw

• Tooth decay, abscesses, cracked teeth and gum disease make chewing painful.
• Mouth ulcers, cold sores, thrush and burns hurt when food touches them.
• Dry mouth from medicines, radiation or Sjögren's syndrome makes dry foods hard to chew and swallow.
• TMJ disorder causes jaw pain, clicking and limited opening.
• Poorly fitting dentures, especially after weight loss, cause sore spots.

Throat and esophagus

Trouble swallowing is called dysphagia.

• Sore throat, tonsillitis and peritonsillar abscess make swallowing painful.
• Acid reflux (GERD) can inflame and, over time, narrow the esophagus.
• An esophageal stricture causes solid foods such as meat and bread to stick, while liquids pass.
• Eosinophilic esophagitis, an allergic inflammation, causes food impaction, often in young men with allergies.
• Achalasia makes both solids and liquids stick and causes regurgitation.
• Cancer of the esophagus causes progressive sticking, first with solids, then liquids, plus weight loss.

Nerve and muscle problems

Stroke, Parkinson's disease, multiple sclerosis, ALS, myasthenia gravis and dementia can weaken the muscles of swallowing. Food or drink may go into the airway, causing coughing, a wet voice after eating, and chest infections (aspiration pneumonia). Some people have "silent aspiration" with no cough.

Stomach and digestion

Indigestion, ulcers, gastritis, gastroparesis (slow stomach emptying, common in diabetes), constipation and gallbladder disease make you feel full, bloated or nauseous after small amounts. Stomach cancer can cause early fullness and weight loss.

Appetite and mental health

• Infections, fever and any acute illness reduce appetite temporarily.
• Depression and anxiety commonly reduce appetite. Grief does too.
• Medicines such as antibiotics, opioids, chemotherapy, metformin, GLP-1 weight-loss drugs and some antidepressants cause nausea or poor appetite.
• Eating disorders such as anorexia nervosa and avoidant/restrictive food intake disorder (ARFID) cause restriction, fear around food or avoidance of textures.
• In older adults, reduced taste and smell, loneliness, cognitive decline and difficulty shopping or cooking all contribute.

Children

Babies and young children can have feeding problems from reflux, cow's milk allergy, tongue-tie, developmental conditions or sensory aversions. See feeding problems.

How doctors find the cause

A doctor will ask what exactly is difficult, which foods cause problems (solids, liquids or both), whether it is getting worse, and about weight loss, heartburn, medicines, mood and other symptoms. They will examine the mouth, teeth, throat, neck and nervous system.

Tests depend on the clues:

• Dental exam for mouth and tooth causes.
• Bedside swallow test and videofluoroscopic swallow study (an X-ray of swallowing with barium) or a FEES camera test, done with a speech-language pathologist.
• Upper endoscopy to look at the esophagus and stomach and take biopsies; it can also stretch a narrowing.
• Barium swallow or esophageal manometry for achalasia and motility problems.
• Blood tests for anemia, thyroid, diabetes, inflammation and nutrition.
• Mental health screening for depression or an eating disorder.

Treatment and practical tips

Treatment targets the cause: dental work, antifungals for thrush, acid reducers for reflux, stretching a stricture, swallowing therapy after stroke, medicine changes, or therapy for depression or an eating disorder.

While the cause is treated:

• Choose soft, moist foods: soups, yogurt, eggs, fish, mashed vegetables, smoothies.
• Eat small meals 5 or 6 times a day rather than 3 large ones.
• Sit upright to eat and stay upright for 30 minutes after.
• Take small bites, chew well and do not talk while swallowing.
• Avoid very hot, spicy, acidic or crunchy foods if your mouth or throat is sore.
• For poor appetite, add calories with olive oil, nut butters or full-fat dairy, or try nutrition shakes.
• If a speech-language pathologist recommends thickened liquids or texture-modified foods, follow their plan exactly.

Frequently asked questions

Why is it suddenly hard for me to eat?

Sudden difficulty is most often from a mouth ulcer, dental problem, sore throat or short illness that kills appetite. If swallowing suddenly becomes hard with face or arm weakness or slurred speech, call 911 for possible stroke. Food stuck in the chest that will not pass needs the ER.

When is difficulty eating serious?

See a doctor if food sticks, if you cough or choke during meals, if you are losing weight without trying, if you feel full after a few bites for more than 2 weeks, or if it hurts to swallow for more than a week. These signs need assessment.

What helps if it hurts to eat?

Soft, cool, bland foods are easiest. Rinse with warm salt water for mouth sores, and use acetaminophen (paracetamol) or ibuprofen for pain, following the label dose. See a dentist for tooth pain. Pain lasting more than a week, or with fever, needs a medical check.

Can anxiety make it hard to eat?

Yes. Anxiety can cause nausea, a tight throat (globus sensation) and loss of appetite. It does not cause food to truly stick. If you have true food sticking, coughing or weight loss, get checked for physical causes even if you are anxious.

How can older adults with eating difficulties get enough nutrition?

Offer small, frequent, energy-dense meals, adapt textures to what is safe, and treat dental and denture problems. Check medicines that dull appetite. A speech-language pathologist and dietitian can assess swallowing and nutrition, and social support at mealtimes helps many people eat more.