Is my child swallowing correctly? Can a speech pathologist help?

After a visit to the dentist or the orthodontist many parents are told their child has an infant or atypical deglutition, other doctors notice how their patient’s tongue tends to rest in the inferior teeth. Some doctors may even suggest a child must have treatment with a Speech pathologist before starting the orthodontic treatment in order to avoid further complications or delays with the process.

When children are transitioning from mixed to all permanent teeth, several changes alter their facial bones and muscular structures (stomatognathic system). It is during this stage when a child transitions from an infant swallowing to an adult pattern of swallowing. Due to unknown causes many children do not transition to an adult pattern in swallowing when they replace all of their teeth. This persistency in an infant swallowing pattern is known as atypical deglutition.

Children or adults with atypical deglutition may have a hard time closing both lips. They push the tongue down and forward toward the teeth, the jaw moves backward therefore the body of the tongue moves down and away from the hard palate. Some children even bite their tongue when doing this movement.

The correct swallowing pattern occurs when both lips are in contact. The tip of the tongue moves up against the hard palate, followed by the body of the tongue pushing against the medial part of our palate. This sequence creates a correct arch form and dental alignment.

Many adults and teenagers have an atypical deglutition and sometimes only notice it after finishing an orthodontic treatment, when their teeth move back to the starting position. This is due to the constant pressure the tongue makes against the incisive teeth, pushing them open.

One of the most common effects of a lack of strength in the tongue is being an oral breather. Being an oral breather has a big impact in all aspects of our life, in severe cases it might even lead to sleep apnea (moments of non-oxygenation while sleeping). Improper oxygenation in children can lead to restlessness, lack of focus and even affect the growth and development of the whole orofacial system.

People who have an infant swallowing pattern can also attribute it to a suction habit with no nutritious purposes. It can be common for children or even adults develop a habit of sucking on a blanket, fingers or baby bottles. A persistent suction pattern leads to less strength and an incorrect position of the tongue.

Several people might even have nutritional side effects, such as needing to make more effort eating solids and hard to chew foods, and therefore end up not consuming several food groups.

As an alteration of the facial and chewing muscles is present, when having an atypical deglutition, most children might experience articulation difficulties. This does not mean that every child who suffers from articulation problems has atypical deglutition or vice versa.

If you suspect that your son/ daughter or even yourself might have atypical deglutition these are some of the symptoms to look out for:

• When swallowing the tongue is placed between the teeth. An open bite tends to develop.
• Having difficulties chewing solids, or swallowing a big amount of liquids. Most oral breathers even state they experience difficulties when chewing and breathing at the same time.
• A child with a breathing pattern will keep his mouth open when watching television, playing, reading or during daily activities.  The tongue will be placed on the lower area of the mouth and rest in the inferior incisive teeth.
• As the mouth tends to be open some drooling when sleeping or during daily activities might occur. Lips tend to lack the strength to stay closed.
• When swallowing the child might make head movements, weird sounds, sucking of the lower lip, changing head postures etc…

All of these side effects can develop because of the lack of strength in the muscles that build up the tongue and facial expression.

Dentists and orthodontists are directly involved in treatment, but a speech pathologist with a specialisation in myotherapy can also help as we intervene in the re-education of breathing, strengthening exercises, and getting rid of inadequate suction patterns.

Treatment is not aggressive and tries to be the least invasive as possible. Keep in mind that to strengthen a muscle a specific exercising routine must be followed. The tongue is no different from the muscles in your legs or arms, and to build up strength a daily effort must be made. A weekly session with the speech pathologist will be held to help you learn the exercises and as progress is made monthly visits will be required.

If you have any more questions or think you or a relative may have a swallowing difficulty, don’t hesitate to contact us. We will gladly answer any doubts or arrange for an appointment with one of our specialists.

Vanz, Rúbia Vezaro, Rigo, Lilian, Vanz, Angela Vezaro, Estacia, Anamaria, & Nojima, Lincoln Issamu. (2012). Interrelation between orthodontics and phonoaudiology in the clinical decision-making of individuals with mouth breathing. Dental Press Journal of Orthodontics, 17(3), 1-7. https://dx.doi.org/10.1590/S2176-94512012000300010

Machado Júnior, Almiro José, & Crespo, Agrício Nubiato. (2012). Avaliação cefalométrica de via aérea e do osso hioide em crianças com deglutição normal e atípica: estudo de correlações. Sao Paulo Medical Journal, 130(4), 236-241. https://dx.doi.org/10.1590/S1516-31802012000400006

Jiménez Jiménez, J. (2017). Importancia de la deglución atípica en las maloclusiones. OdontologíA Sanmarquina, 19(2), 41-44. doi:https://dx.doi.org/10.15381/os.v19i2.12917