The role of the dietitian

THE ROLE OF THE DIETITIAN IN SUPPORTING A PERSON LIVING WITH DYSPHAGIA

The roles and responsibilities of health professionals in Québec are defined by the Code des professions du Québec:

https://www.legisquebec.gouv.qc.ca/fr/document/lc/c-26

As stated in this Code, the legal scope of practice of dietitians includes: assessing a person’s nutritional status, determining and implementing an intervention strategy aimed at adapting nutrition to meet needs in order to maintain or restore health.

Each health profession has activities that are reserved by law. Dietitians have two reserved activities:

1. Determining the nutritional treatment plan, including the choice of feeding route
2. Monitoring the nutritional treatment plan

Dietitians are therefore the professionals responsible for determining whether adapted food textures or liquid consistencies are appropriate for a person’s swallowing disorder.

Eating is a fundamental act — vital, but also deeply tied to pleasure, culture, and identity. When a person has dysphagia, eating can become complex, risky, and anxiety‑provoking.

The dietitian plays a central role in ensuring safety, maintaining nutritional status, and supporting quality of life, based on the person’s swallowing capacity, living environment, and personal goals, while respecting dignity and promoting the pleasure of eating.

Assessing Nutritional Status and Swallowing

The first step is a comprehensive nutritional assessment.

The dietitian:

• Analyzes nutritional status (weight, dietary intake, risk of malnutrition)
• Evaluates needs for energy, protein, vitamins, minerals, and fluids
• Considers cognitive status, physical condition, and level of alertness
• Conducts an in‑depth review of health conditions associated with dysphagia (stroke, surgery, neurodegenerative disease, major cognitive disorders, extubation, cancer, etc.) and other medical conditions (e.g., diabetes, heart failure, kidney disease)

The dietitian may perform a screening or full clinical swallowing assessment (e.g., bedside meal observation), independently or in collaboration with other professionals. When needed, the assessment may be complemented by specialized instrumental exams such as videofluoroscopy or endoscopy.

This combined assessment (nutrition + swallowing) determines whether the person can safely eat by mouth and establishes the precautions required to ensure the safest possible swallowing.

Interdisciplinary Collaboration

Depending on the care setting, the dietitian works closely with speech‑language pathologists, occupational therapists, physicians, nurses, and sometimes respiratory therapists.

This coordinated approach aims to ensure safety, comfort, and quality of life.

Determining the Nutritional Treatment Plan

The dietitian is responsible for:

• Determining the nutritional treatment plan
• Choosing the appropriate feeding route:
  • Oral
  • Enteral (nasogastric tube, gastrostomy)
  • Parenteral (intravenous)
  • Mixed (combination of two routes)
• Adapting food textures and liquid consistencies
• Ensuring that nutritional and hydration needs are met (poorly adapted modifications can lead to malnutrition, dehydration, or medical complications)

The dietitian explains the risks and benefits of each texture or consistency modification.

The plan must preserve nutritional balance, a healthy relationship with food and hydration, and the pleasure of eating — not only meet nutrient and fluid requirements.

Preventing Risks and Complications Associated With Dysphagia

Dysphagia is strongly associated with increased risk of:

• Choking
• Aspiration pneumonia
• Malnutrition and muscle loss
• Dehydration
• Social isolation
• Loss of pleasure in eating

The dietitian develops personalized strategies to reduce these risks while respecting the person’s abilities, expectations, goals, and preferences, enabling informed decision‑making.

Supporting the Patient and Their Caregivers, and Ensuring Feasibility

A nutritional plan must be realistic and applicable in the person’s living environment, considering knowledge, skills, and financial resources.

The dietitian provides education to the person with dysphagia and supports them and their caregivers in:

• Understanding the rheological properties of foods (sensory characteristics such as stickiness, multiphase foods, crumbly textures, etc.)
• Preparing safe adapted textures and consistencies
• Reading labels and choosing appropriate commercial products
• Organizing meals according to available equipment and abilities
• Finding solutions when home preparation is difficult

The dietitian supports the person and their loved ones with respect, listening, and collaboration.

They also identify educational and community resources available to support the person living with dysphagia and their caregivers.

Monitoring and Adjusting the Nutritional Plan

The nutritional plan requires regular follow‑up.

The dietitian:

• Reassesses swallowing capacity
• Monitors weight changes and dietary intake
• Ensures the treatment remains safe and effective
• Supports meal preparation according to the established textures and consistencies, aligned with needs and expectations

The ultimate goal remains the same: maintaining or restoring health while promoting dignity and quality of life for the person living with dysphagia.

Dietitians work primarily in acute‑care hospitals, home care, long‑term care facilities (CHSLDs), community settings, and private practice.

You can consult the ODNQ website to find a qualified professional in this field: