What’s Atypical Swallowing?

Atypical swallowing is a condition that affects the human swallowing process. It has dental, digestive, and respiratory consequences. In this article, we'll explain what it is and how doctors diagnose it.

Written and verified by the doctor Leonardo Biolatto.

Last update: 27 May, 2022

For a person to be diagnosed with atypical swallowing, their tongue must adopt an inappropriate posture when swallowing. This means that the tongue is positioned in a place that doesn’t favor the ingestion of food.

Physiologically, the tongue plays a unique role in the swallowing process. When food enters the mouth, the tongue directs it towards the pharynx so that it can make its way to the digestive tract.

Atypical swallowing is when the tongue has a counterproductive posture during swallowing or is used in a way that doesn’t favor this food transit. In fact, it’s more functional than anatomical in its nature.

The phases of swallowing

Swallowing usually has three phases. These phases are: oral, pharyngeal, and esophageal. In atypical swallowing, the first phase is altered.

• Oral: Atypical swallowing affects this phase. It consists of the moment when food enters the oral cavity. Saliva is secreted, the food is chewed, and the tongue finally pushes it to the pharynx.
• Pharyngeal: It’s an involuntary phase where the food bolus moves to the esophagus.
• Esophageal: It’s the final phase of swallowing. It’s also involuntary and consists of the bolus moving to the stomach.

The symptoms of atypical swallowing

A series of signs make it evident that a person suffers from atypical swallowing. These are the same signs health professionals analyze to diagnose the disorder.

The symptoms include:

• At rest, the tongue isn’t located against the roof of the mouth but between the teeth.
• The person breathes mainly through the mouth rather than through the nose. In childhood, it’s associated with the typical picture of a mouth breather.
• The upper and lower teeth lose contact and a permanent distance between the two dental arches is caused. Partly due to the interposition of the tongue and also due to mouth breathing.
• Swallowing is noisy, as it requires more effort.
• Food isn’t processed correctly in the first phase of swallowing. The tongue doesn’t propel the bolus towards the pharynx. In advanced cases, this causes the person to make head movements to move the food towards the second swallowing phase.
• The muscles of the face, those closest to the lips, become flaccid. The proper term for this is hypotonia.

The causes of atypical swallowing

Atypical swallowing is more common in children than in adults. This is partly because the causes are related to the development and congenital anatomical structure at birth and growth during the first years of life.

Here are the most common causes of atypical swallowing:

• Prolonged pacifier use: When children use a pacifier for more than a year and a half, it no longer facilitates oral cavity formation but begins to negatively affect teeth development. Furthermore, it doesn’t allow the tongue to take the required position.
• Finger or bottle sucking: Due to the same reasons we mentioned above. When a child drinks from a bottle for longer than indicated, or the child sucks their finger, the tongue doesn’t learn its function.
• Adenoid hypertrophy (enlarged adenoids): The tonsil and adenoid system may be enlarged in some children. Under these conditions, it’s hard for air to enter and it’s also hard for the person to swallow. The solution is treating the hypertrophy with drugs or surgery.
• Tongue-tie: This is a birth disorder in which a child is born with an unusually short, thick, or tight band of tissue (lingual frenulum). This will limit their tongue movements, causing atypical swallowing.
• Ankyloglossia, a rare disorder where the muscles of the tongue are stiff.

Possible treatments

There are no specific drugs to treat atypical swallowing. The treatment consists of reeducating the tongue and solving the cause that may be behind the disorder.

If the patient suffers from tongue-tie or adenoid hypertrophy, they’ll need surgery. However, after surgery, they’ll still require subsequent rehabilitation.

One of the professionals that usually plays a role in rehabilitation is the orthodontist. Their role in the treatment is to correct malpositioned teeth so that the upper and lower arches take the normal positions.

The other fundamental rehabilitation professional is a speech therapist. Speech therapists re-teach children and their tongue how to position itself, where to position itself, and how to pronounce words and chew.

In short, parents need to pay attention to their children, including how they chew, how they breathe, and how they speak. If you believe your child may suffer from atypical swallowing, you’ll need to take them to see a doctor.