Swallowing: What the Mouth Does

Try It!
Take a sip of liquid and notice how it feels to swallow. Notice how your lips shut, cheeks pull in. and tongue moves to the roof of your mouth behind your top teeth. There seems to be a "wave action" which moves the liquid back toward your throat. Let's see how children develop a mature swallow like the one you just experienced.

Your Child's Swallow
Children learn to swallow in a progression. Swallowing of liquids generally comes first. Swallowing strained foods occurs next, followed by the swallowing of more textured chewed table foods. When babies first swallow, they use mostly an in-and out tongue movement. The tongue may actually push forward slightly through the lips at the moment of swallowing. Gradually, babies become belter able to move their tongues up and down and keep the tongue in the mouth while swallowing.

This is the swallow pattern you felt when you tried it. Once this elevated tongue tip position is developed, infants lose less liquid during swallowing and usually stop pushing the liquid forward. It is a very important component of swallowing and signals the beginning of a mature swallow.

Position during Swallowing
For young babies, the position during feeding affects how well they swallow and close their lips. When held with their chins in a tucked position, babies are able to keep their lips together better and so push their tongues forward less

You may want to try this one, too. Swallow with your head held way back. You can feel the tension in your neck. Swallowing is strained. Your jaw would rather be opened slightly; closing it makes swallowing even harder. Your tongue probably feels more tension and has more difficulty getting to the roof of your mouth to help with the swallow. If your lips were opened when you swallowed, you felt that push forward by the tongue at the moment of swallow. Inefficient, wasn't it? By swallowing again with a good chin tuck, you can feel that the position of your head is very important for swallowing.

What Happens When Your Child Swallows?
Most of us swallow without even thinking about it. But in fact, each time we swallow, a delicate process is set in motion involving several parts that must work together in perfect harmony. If one or more of these parts isn't working properly, swallowing becomes a problem.

Let's take a look at the structures of the child's mouth, throat, and neck that are involved in swallowing and how they coordinate to move food efficiently from the mouth to the stomach.

This is the swallow pattern you felt when you tried it. Once this elevated tongue tip position is developed, infants lose less liquid during swallowing and usually stop pushing the liquid forward. It is a very important component of swallowing and signals the beginning of a mature swallow.

Position during Swallowing
For young babies, the position during feeding affects how well they swallow and close their lips. When held with their chins in a tucked position, babies are able to keep their lips together better and so push their tongues forward less. You may want to try this one, too. Swallow with your head held way back. You can feel the tension in your neck. Swallowing is strained. Your jaw would rather be opened slightly; closing it makes swallowing even harder. Your tongue probably feels more tension and has more difficulty getting to the roof of your mouth to help with the swallow. If your lips were opened when you swallowed, you felt that push forward by the tongue at the moment of swallow. Inefficient, wasn't it? By swallowing again with a good chin tuck, you can feel that the position of your head is very important for swallowing. What Happens When Your Child Swallows?

Most of us swallow without even thinking about it. But in fact, each time we swallow, a delicate process is set in motion involving several parts that must work together in perfect harmony. If one or more of these parts isn't working properly, swallowing becomes a problem.

Let's take a look at the structures of the child's mouth, throat, and neck that are involved in swallowing and how they coordinate to move food efficiently from the mouth to the stomach.

Think of the swallowing system as a long tube from the mouth to the stomach. Food or liquid is pushed by wave-like muscle contractions along the tube and into the stomach. This tube has valves that close to prevent food from entering the nose or windpipe and to keep food from changing direction and coming back up from the stomach to the mouth.

First Phase of Swallowing
The inside of the mouth, known as the oral cavity, has several components: the upper and lower jaw, lips, cheeks, tongue, teeth, floor of the mouth, hard and soft palate, uvula, and faucial arches (see diagram).

In the first phase of swallowing, the oral cavity prepares the food for swallowing. The food is chewed and mixed with saliva, then made into a bolus or collected mouthful of food ready for swallowing

Next, the lips close, the cheeks draw in, and the tongue wwks in a wave-like movement to push the food bolus toward the back of the tongue. There, the swallow reflex is triggered as the food moves over the back of the tongue. As valves open and close in the throat, the pressure froi he mouth to the throat changes and the food bolus is moved
toward the throat (pharynx).

Second Phase of Swallowing
As the swallow is occurring, several things happen to make sure the food bolus goes into the stomach and not up in the nose or the airway.

The back of the tongue lifts to prevent food from returning to the mouth

The back portion of the roof of the mouth (velum) moves up and back to keep the contents of the mouth from going into the nose.

Third Phase of Swallowing
Finally, the food bolus moves past the airway. Next, the muscles at the top of the esophagus open to let it pass into the esophagus. These muscles then close immediately, to prevent the food from coming back up into the throat. Once in the esophagus, a wave-like muscle action known as peristalsis moves the food downward toward the stomach. A valve at the bottom of the esophagus closes after the bolus enters the stomach, to prevent food from backing up or refluxing out of the stomach.

Valving Can Work Improperly
Obviously, swallowing is a pretty finely tuned process. Since it is done so close to the airway, there always is a risk of aspiration (taking in food or liquid to the lungs) if the valve system fails. In addition, food or liquid can be misdirected into the nose or airway if valves don't close completely and at the correct time.

Sometimes food slips down the back of the throat before the swallow reaction is triggered or if the swallow is triggered too slowly. In most cases, a child will cough to protect the airway. But sometimes the food bolus slips down without causing a cough.

Then the food can rest in the pockets just above the epiglottis, in the valleculae or pyriform sinuses. These pockets should clear out with the next swallow, but if for some reason they don't, food can spill over into an unprotected airway. At other times, the vocal cords don't close completely and material from the food bolus slips into the lungs that way.

Material also can back up, or reflux, from the stomach. This material can sneak back up into the throat (pharynx) and slip into an unprotected airway.

If your child is having difficulty swallowing, discuss these issues and your concerns with your child's doctor. Concerns about your child's swallowing and the possibility of aspiration may lead your doctor to recommend a videofluoroscopic swallow study. The purpose of this study is to look at how your child swallows and rule out the possibility of aspiration.

Swallowing Problems
Swallowing is affected by many different factors. Children with no other eating difficulties may choke or sputter when swallowing if they: -

Are fed foods that are too difficult for them, foods they are not yet ready to handle

Eat too rapidly

Try to swallow before chewing completely

Try to talk while swallowing

Are forced to eat a food they don't like

For other children, swallowing can be a challenge. These factors can be a cause of swallowing difficulties: -

Poor muscle control

Neurological or medical difficulties

Poor position for swallowing

Poor jaw control

Inefficient cheek and lip control

Uncoordinated or immature tongue movements

Oversensitivity to textures

Poor chewing

Poor organization or attention to the food