What Is Atypical Swallowing?

Atypical swallowing is a condition in which the human swallowing process is affected. It has dental, digestive and respiratory consequences. This article explains what it is and how it is diagnosed.
What is atypical swallowing?

To receive a diagnosis of atypical swallowing, the tongue must assume an inappropriate position when swallowing. This means that it is positioned in places that do not favor food intake.

Physiologically, the tongue plays a unique role in the swallowing process. When food enters the mouth, it is responsible for directing it to the pharynx to then be sent to the digestive tract.

If the tongue assumes a counterproductive position during swallowing, or is used in a way that does not favor this transit of food, then we speak of atypical swallowing. It’s a functional concept rather than an anatomical one.

Swallowing phases

The act of swallowing usually has three phases, and in atypical swallowing, the first phase is altered. These phases are: oral, pharyngeal and esophageal.

  • Oral: This first phase is where atypical swallowing occurs, when it exists. It consists of when food enters the oral cavity, saliva is secreted, food is chewed, and the tongue finally propels it into the pharynx.
  • Pharyngeal: is an involuntary phase where the bolus passes through to reach the esophagus.
  • Esophageal: this  is the final stage of swallowing, also involuntary, when the bolus passes through the stomach.

Symptoms of atypical swallowing

When a person has atypical swallowing, this becomes apparent through a series of signs. These same signs are used by health professionals to define the diagnosis of the disorder. Symptoms include:

  • The tongue, at rest,  is not located against the palate, but between the teeth.
  • The person breathes mainly through the mouth, not through the nose. In childhood, it is associated with the typical picture of mouth breathing.
  • The top and bottom teeth lose contact, and a permanent distance is generated between the two dental arches. This is partly because of tongue thrusting, and also because of mouth breathing.
  • Swallowing is noisy as it requires more effort.
  • Food is not processed correctly in the first stage of swallowing. The tongue does not push the bolus towards the pharynx with sufficient force, which makes the person, in advanced cases, to make head movements to move the food to the second phase of swallowing.
  • The facial muscles, those closest to the lips, become flaccid.  The proper term is muscle hypotony.
Chew food well
Patients with atypical swallowing have difficulty ingesting food. In addition, the condition may be accompanied by some respiratory symptoms.

Causes of atypical swallowing

Atypical swallowing is diagnosed more in children than in adults. Partly because  the causes have to do with development and congenital anatomical structure at birth and growing during the first years of life.  The most common causes of atypical swallowing are:

  • Prolonged use of a pacifier: when the use of a pacifier exceeds one and a half years of life, it starts to be counterproductive for dental development. Furthermore, it does not allow the tongue to assume the necessary position.
  • Bottle or finger sucking: with the same criteria as the pacifier, when the bottle is used for longer than indicated or the child sucks the finger, the tongue does not learn its function.
  • Adenoid hypertrophy: the tonsil and adenoid system may be increased in size in some children. Under these conditions, air enters with difficulty and swallowing is also difficult. It is a cause that finds its solution in the treatment of hypertrophy with medication or surgery.
  • Short lingual frenulum: the child may be born with a lingual frenulum shorter than it should. This will limit the tongue movements, generating an atypical swallowing picture.
  • Tongue-tied ( ankyloglossia) : is a rare disease in which the muscles of the tongue become hardened.
Doctor examining tonsils
Amygdala hypertrophy is one of the causes of atypical swallowing in children.

Possible treatments

There are no medications to specifically treat atypical swallowing. Rigorous treatment consists  of language re-education and the mechanical solution of the cause that may be behind the  disorder.

Of course, if there is a short lingual frenulum or adenoid hypertrophy, then surgery will be performed. However, even if this basis is resolved surgically, rehabilitation will be necessary.

One of the professionals who usually intervene in rehabilitation is the orthodontist. Its function in processing is to correct dental deviations to make the upper and lower arches assume normal positions.

The other fundamental rehabilitation professional is the speech therapist. Speech-language pathologists teach the child to position the tongue, pronounce the words and chew correctly.

As parents, it is important to pay attention to our children: how they chew, how they breathe and how they speak. When there is a suspicion of atypical swallowing, it is important to consult a pediatrician.

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