Family Caregiver Cheatsheet: Cantonese-Speaking Hong Kong Families

Caring for a family member with dysphagia at home in Hong Kong involves navigating a healthcare system that uses clinical terminology, cultural food norms that may conflict with dietary prescriptions, and the practical challenges of mealtime management without professional support on-site. This cheatsheet is designed to be printed, stuck to the refrigerator, and referenced every mealtime.

Understanding the Prescription / 了解處方

Your family member has been assessed by a speech therapist (言語治療師) and given an IDDSI food and drink level. This is a medical prescription — it is as important as medication.

Do not change the level without consulting the speech therapist, even if:

• The person says they feel better
• You think the food “looks” safe
• A previous level worked fine

The speech therapist’s contact: _______________ Next review date: _______________

IDDSI Levels in Plain Cantonese / IDDSI等級（廣東話說明）

Common Hong Kong Foods — Safe or Not? / 常見香港食物安全與否？

粥 Congee

• Plain congee (白粥) cooked until very soft and smooth ≈ Level 4–5 ✓ (for Level 4–5 patients)
• Congee with toppings (ingredients added on top) = mixed texture ⚠️ — remove or blend all toppings
• Thin congee water (粥水) = Level 0 thin liquid — not safe for Level 1+ patients unless thickened

湯 Soup

• Clear soup (清湯), wonton soup liquid, herbal soup = Level 0 thin liquid
• Must be thickened to the prescribed level before serving
• Thick cream soup or blended soup may be Level 3–4 but varies — test consistency

豆腐 Tofu

• Silken tofu (嫩豆腐, 豆腐花) = Level 4–5 naturally ✓
• Firm tofu (硬豆腐) = may fail Level 6 fork test — needs cooking until soft

蛋 Eggs

• Soft-scrambled eggs (嫩炒蛋), steamed egg (蒸水蛋), soft-boiled egg (溏心蛋) = Level 5–6 ✓
• Hard-boiled egg = Level 7 (too firm for Level 6 and below)

魚 Fish

• Steamed white fish (蒸魚), cod, tilapia = Level 6 if bones fully removed ✓
• Salted fish (鹹魚) = often very salty and firm; requires cooking until soft

點心 Dim Sum

• Har gow, siu mai wrappers = chewy, mixed texture ✗ (never safe for Level 6 and below)
• Cheung fun (腸粉) = may pass if soft and served with sauce, no mixed textures
• Lo mai gai (糯米雞) = sticky rice problematic for most dysphagia levels

Danger Signs During Meals / 進食時的危險信號

Stop feeding and sit them upright if you notice:

🔴 Coughing or choking during or immediately after eating/drinking 🔴 Wet, gurgling, or hoarse voice after swallowing — this is a key sign of aspiration 🔴 Food or drink coming back out from mouth or nose 🔴 Facial colour change — pallor or bluish lips 🔴 Refusing food or distress at mealtimes — this may indicate pain or fear

If breathing stops: Call 999 immediately (救護車)

After any choking episode, even if the person recovers fully:

• Keep them upright for 1 hour
• Document the time and what happened
• Call the speech therapist or GP for review

Daily Mealtime Checklist / 每餐前確認清單

Print and use before every meal:

• Person is seated upright at 90° / 坐直90度
• Correct IDDSI level food prepared and checked / 正確IDDSI等級
• Drinks thickened correctly if required / 飲品正確增稠
• Feeding pace is slow — one small mouthful at a time / 每次一小口，慢慢餵
• Oral care done before eating (reduces aspiration pneumonia risk) / 餐前口腔護理
• Eaten in quiet environment, no TV distractions / 安靜環境進食
• Remain upright 30 min after meal / 餐後保持坐直30分鐘

Tips for Common Challenges / 常見困難應對

“家人唔想飲增稠嘅飲品” / Person refuses thickened drinks:

• Switch to a clear, flavourless xanthan gum thickener (黃原膠類增稠劑) which is nearly tasteless
• Offer favourite drinks (e.g. chrysanthemum tea 菊花茶, soy milk 豆漿) thickened rather than plain water
• Small, frequent sips throughout the day

“晚上餵完水佢咳” / Coughing after night drinks:

• Never give drinks lying down — always sit up first
• Night-time aspiration is common; consider placing thickened water by the bedside (not unthickened)
• Report to speech therapist

“到朋友屋企食飯點算” / Eating at friends’ or relatives’ homes:

• Bring your own thickener powder
• Call ahead to explain dietary requirements
• Identify safe dishes from the menu before sitting down

Emergency Chinese-Language Phrase Card

For situations where you need to explain the dietary restriction quickly in Chinese:

「佢患有吞嚥困難，唔可以飲普通水或者食普通固體食物。請唔好畀佢飲湯、茶或者任何未增稠嘅飲品。請聯絡言語治療師或者急症室。」

(He/She has dysphagia and cannot drink normal water or eat regular solid food. Please do not give soup, tea, or any unthickened drinks. Please contact the speech therapist or emergency department.)

Useful Resources / 實用資源

• IDDSI Level Guide for Hong Kong Carers
• Thickener Comparison for Hong Kong
• Aspiration Pneumonia Prevention
• Hospital Authority Patient Resource Centre (醫院管理局病人資源中心): various RCHE districts

This cheatsheet is for practical daily use and does not replace professional assessment. All IDDSI levels must be prescribed by a speech-language pathologist. When in doubt, call the speech therapist.