Understanding & Managing Dysphagia in Schools

Dysphagia, or difficulty swallowing, is a critical concern in educational settings, particularly in specialist (SEN or SEND) schools supporting students with complex needs. However, due to various risk factors, dysphagia can present itself across all school settings, so a robust strategy should be in place to meet requirements safely as needed. OHK is at the forefront of supporting schools in developing comprehensive dysphagia management approaches, providing training, guidance and practical solutions to improve food safety, quality and accessibility for students affected by dysphagia.

Who is at risk?

Students at high risk for swallowing disorders include those with:

• Cleft palate, cerebral palsy, autism, traumatic brain injury (TBI) and neurological impairments.
• Nutritional deficiencies, low birth weight, ADHD and eating disorders.
• Medication-related side effects (diuretics, antihypertensives, antidepressants).

In specialist (SEN or SEND) schools, dysphagia prevalence is significantly higher due to the complexity of student needs.

Guidance for students with dysphagia includes clinical recommendations from Speech and Language Therapists (SLTs), therapeutic interventions, and food and drink texture modifications. These modifications are critical to ensure safety and accessibility, requiring collaboration between teachers, support workers and catering teams.

Texture modification and IDDSI standards:

Key challenges

Ensuring food safety for students with Dysphagia

School catering teams implement rigorous food safety measures, including HACCP systems and allergen controls. However, texture modification introduces additional complexities and should be identified as a food safety risk:

• Adherence to the International Dysphagia Diet Standardisation Initiative (IDDSI) framework is essential.
• Food safety risks arise if recommended texture levels are not maintained throughout preparation and service.
• Schools must ensure that modified meals do not compromise on choice, quality or appeal to students.

KEY CHALLENGE: Creating safe and nutritious texture modified meals that showcase well-established favourites and appeal to young people.

Commitment to best practices in schools

Recognising the need for structured training, schools and contract caterers are increasingly integrating IDDSI-aligned training programs. This ensures that:

• Catering staff are well-trained in dysphagia-friendly preparation methods.
• Schools implement dysphagia catering strategies at a policy level.
• There is alignment with best practices seen in the health and social care sector. For a deeper dive into the social care sector download the recent OHK x Care England white paper.

Creating an inclusive meal service

Students with dysphagia should have access to the same menu choices as their peers and caterers should be able to produce these modified options with minimal additional resources – especially time, skills, equipment and budget.

Integrating catering for dysphagia into school kitchens is achievable, however it does require a confident and well organised team. Catering skills in school kitchens are of a high standard and can be used very effectively to create foods for IDDSI diets.

Key outcomes from IDDSI-trained catering teams:

• Improved safety and compliance in dysphagia meal preparation.
• Reduced food waste and cost savings through efficient preparation methods.
• Enhanced dining experience with meals that maintain quality and appeal.

Operational challenges and solutions

Providing a safe dysphagia food service requires maintaining food texture integrity from kitchen to consumption. Challenges include:

• Ensuring texture consistency when food is held in canteen serveries or transported within the school.
• Ensuring staff across departments understand the importance of food safety in dysphagia management.
• Contract caterers often face additional challenges, such as inadequate equipment for IDDSI-compliant food preparation.

Feedback from ISS: “The OHK training will improve the confidence of our catering teams when producing IDDSI meals for children and young people. We feel OHK is the most suitable programme for ISS because of the rare, and high level, of expertise and knowledge both James and Preston can impart with our placemakers. The IDDSI framework, and in turn, the production of IDDSI meals is a specialised area. It is imperative training in this field is detailed and correct, to minimise any potential risk with the production and service of these meals within our Education business.” Clare Harper – Nutritionist, ISS UK

Developing a systematic approach to Dysphagia catering

Each school must tailor its dysphagia meal provision to local needs while maintaining core principles of best practice. Key factors include:

• Effective communication between catering, education, and healthcare teams.
• Structured menu design that accommodates dysphagia-friendly modifications.
• Ongoing training to ensure staff competency.
• Investment in appropriate kitchen equipment to support IDDSI-compliant meal preparation.
• Streamlined delivery and service workflows to maintain food texture integrity.

Proof of success: A systematic approach with FASSCO led to 100% compliance over a three-month testing period in a complex production and delivery system.

Enhancing safety through a whole-school approach to Dysphagia awareness

Safety in school meal provision is maximised when all staff – teachers, catering teams and support workers – are equipped with the knowledge to identify and support students with dysphagia.

• The Eating, Drinking, and Swallowing (ED&S) competency framework promotes an integrated approach across school teams.
• Best practice guidelines enhance staff confidence in managing dysphagia risks.
• Collaboration ensures students receive the best support possible.

Implementing the ED&S competency framework led to measurable improvements in patient safety and staff confidence in East Sussex Healthcare NHS Trust. With an initial 85% reduction in choking incidents, continual improvements year on year, and no ‘never’ events, it’s now seen as a vital part of MDT training within the Trust.

The training has also created a positive impact in Orchard Hill College & Academy Trust.

“The EDS e-modules have been an invaluable resource to the Speech Therapy Service across our different college sites.

In the face of difficulties with recruitment of dysphagia trained SLTs and high agency support staff turnover, the e-learning modules and programme provide by OHK has opened possibilities for the SLT Service to allocate support staff onto the e-modules which cover dysphagia awareness, dysphagia care plan implementation and identifying need for amended mealtime plans. 

The e-modules allow the SLT service to capture which staff completed the modules with baseline measurements of EDS awareness and competencies across different locations and college sites. In turn, this has freed up time for the Speech Therapists to focus resources more effectively on more complex dysphagic students’ and related MDT work across our integrated services team.” Lindsay Walker, Orchard Hill College

Want to ensure safe, high quality, inclusive meal services?

Speak with OHK, global experts in food texture modification and IDDSI. OHK is committed to supporting schools in delivering safe, high-quality, and inclusive meal services for students with dysphagia. By implementing structured training, adopting IDDSI standards, and encouraging cross-department collaboration, schools can create sustainable, effective dysphagia management strategies that enhance student safety and dining experiences.

For further information on our award-winning training solutions incorporating the Eating, Drinking & Swallowing Competency Framework and Catering for Dysphagia Diets and IDDSI, get in touch: info@oakhouse-kitchen.com