In caring for a patient with ALS, what safety consideration is essential before feeding?

• A. Check gag reflex before feeding
• B. Ensure patient can sit up unassisted for meals
• C. Start high-calorie supplements immediately
• D. Place feeding tube without assessment

Answer: (A)

In ALS, assessing swallowing safety is crucial before any feeding because bulbar weakness can compromise airway protection and lead to aspiration. A quick gag reflex check at the bedside helps determine if the patient has a protective swallow: if the gag reflex is present, oral intake can often proceed with precautions (slow pacing, small bites, thorough chewing, and ensuring an upright position). If the gag reflex is absent or diminished, oral feeding is unsafe and alternatives or a thorough swallow evaluation are needed to prevent dangerous aspiration.

Positioning matters for reducing risk, but it does not replace confirming swallow safety. Starting high-calorie supplements right away assumes swallowing is safe, which may not be true. Placing a feeding tube without first assessing swallow can expose the patient to unnecessary risks and delays proper care.