Atypical swallowing: what it is, signs, and how to treat it.

Mealtime should be a peaceful moment, but it's not always that way. When the tongue pushes against the teeth, the mouth remains slightly open, chewing is difficult, or swallowing feels like an effort, atypical swallowing may be present.

This condition is very common in children, but it can also affect adolescents and adults, impacting eating, speech, breathing, and even self-esteem.

In this article, we will clearly explain what atypical swallowing is, what signs to watch out for, and how it is corrected through intervention. Speech therapy. If you prefer, it is also possible to receive support today by Online speech therapy, which facilitates regular and consistent monitoring.

What is atypical swallowing?

Simply put, atypical swallowing refers to when the swallowing pattern does not follow what is considered functional for the age. Instead of a coordinated, discreet, and efficient movement, compensatory patterns are observed, such as the tongue pushing against the teeth, excessive effort from the lips or chin, and exaggerated facial movements during swallowing.

In the classic definition, this pattern is associated with tongue interposition between the teeth, insufficient lip seal, or excessive use of the muscles around the mouth, often related to dental malocclusions. In clinical practice, it is seen as a childhood swallowing pattern that has persisted beyond the expected age or as an adaptation to other alterations, for example, respiratory or structural ones.

It is important to remember that atypical swallowing is not just "an ugly habit" or an aesthetic issue. It is a functional alteration that can interfere with craniofacial growth, chewing, speech, and, in some cases, food safety.

What is normal swallowing like throughout development?

To understand atypical swallowing, it helps to first understand what is expected at each stage of development. The swallowing pattern changes from birth to adulthood, accompanying facial growth, tooth eruption, and the introduction of new food textures.

In simplified terms, the route usually looks like this:

• Baby – Sucking and a reflexive pattern predominate. The tongue moves back and forth, coordinated with breathing and swallowing.
• Transition to solids – Chewing begins, the tongue starts to make more lateral movements, and the lips gain more strength and seal.
• Older child and adult – Functional swallowing becomes more discreet: the tongue rests on the palate (roof of the mouth), the teeth come closer together, the lips close naturally, and there is little visible movement in the chin or face.

When a more infantile pattern persists (for example, the tongue continues to protrude forward or remain between the teeth when swallowing) or when the person develops compensations due to other problems, an atypical swallowing pattern may become established.

Most common causes of atypical swallowing

Atypical swallowing rarely appears "out of nowhere." It usually results from a combination of structural and functional factors, as well as oral habits maintained over time. No two cases are alike, but there are causes that appear repeatedly in clinical practice.

Among the most common causes and risk factors are:

• Prolonged oral habits – prolonged use of a pacifier, thumb sucking, nail biting, biting pencils or other objects, especially if maintained beyond 3-4 years of age.
• Breathing predominantly through the mouth – a Mouth breathing It alters tongue positioning, lip tone, and overall posture, favoring compensatory swallowing patterns.
• Respiratory allergies and nasal congestion - allergic rhinitis, hypertrophy of adenoids Enlarged tonsils can make nasal breathing difficult, pushing the child towards mouth breathing.
• Dental or skeletal changes Open bite, protruding teeth, narrow palate, or other malocclusions may be associated with altered swallowing patterns.
• Changes to lingual frenulum A very short or poorly functioning frenulum can limit tongue movements and lead to compensatory patterns.
• Neurological diseases or syndromes – In some cases, atypical swallowing is part of a broader picture of motor, muscular, or coordination impairment.
• Introduction of food with little variety If a child remains on very soft and unchallenging textures for too long, the muscles may not develop the strength and coordination necessary for functional swallowing.

That is why the assessment of atypical swallowing is never limited to "looking at the tongue": it is necessary to look at breathing, posture, chewing, dentition, oral habits, and the child's or adult's health history.

Signs of atypical swallowing in infants, children, and adults.

It's not always easy for parents, or even the person themselves, to realize that their swallowing habits have changed. However, some signs are quite typical and can be observed in daily life, during meals, or even at rest.

Some common signs of atypical swallowing include:

• Visible tongue between the teeth or pushing against the teeth when swallowing;
• Exaggerated movement of the chin or neck during swallowing;
• Lips that need to "strain" to be able to swallow;
• Food particles remaining in the mouth after swallowing, especially in children;
• Leaking fluid from the corners of the mouth;
• Audible noises when swallowing saliva, water, or food;
• Mouth breathing, often associated with an open mouth at rest;
• The tongue is very "still" in the mouth, not effectively participating in chewing;
• anterior open bite or front teeth that protrude more than normal;
• Misaligned head and neck posture during mealtimes.

In children, atypical swallowing may occur in conjunction with difficulty chewing in children, Selective eating, refusal of certain foods, or fatigue when chewing. In adults, the reason for seeking help is often dental aesthetics, joint pain, a feeling of effort when swallowing, or speech problems.

Consequences of atypical swallowing if left untreated.

Not everyone with atypical swallowing will develop serious problems, but ignoring this pattern over the years can have several consequences. The earlier the intervention, the smaller the long-term impact tends to be. Some of the possible consequences include:

• Changes in dentition and facial growth Open bite, dental misalignment, narrow palate, and other malocclusions can worsen over time, often requiring prolonged orthodontic treatment.
• Chewing and eating problems – difficulty handling harder or fibrous foods, fatigue when chewing, very long or inefficient meals.
• Increased risk of dysphagia in some paintings – In specific cases, especially when there are other associated conditions, altered swallowing can compromise feeding safety.
• Impact on speech - distortions of sounds, "breathy" speech, anterior tongue protrusion or Children's speech problems They may be associated with an altered overall orofacial pattern.
• Discomfort, pain, or muscle tension Tension in the neck, facial, or temporomandibular joint muscles can result from repetitive compensatory movements.
• Psychosocial impact Feeling ashamed to eat in public, fear of choking, or dissatisfaction with one's dental appearance can lower self-esteem.

The good news is that, with proper assessment and a structured intervention plan, atypical swallowing can be addressed with excellent results, especially when there is collaboration between Paediatric speech therapy, dentistry and other health professionals.

Speech therapy assessment and diagnosis

The first step in treating atypical swallowing is a detailed assessment, performed by a speech therapist with experience in orofacial motor skills and feeding function. This assessment is not limited to "looking at the tongue" for a few seconds: it is a comprehensive process that integrates various moments and contexts.

Typically, the assessment includes:

• Initial interview to gather medical history, oral habits, development, medical history, and current complaints;
• Observation of the face at rest, overall posture, breathing, and muscle tone;
• Analysis of the oral structure: lips, tongue, palate, frenulum, teeth, occlusion;
• Observation of chewing with different food textures;
• Observation of the swallowing of saliva, liquids, and solids, safely;
• Video or photographic record, when necessary, for comparison throughout the intervention;
• Collaboration with other professionals (pediatric dentist, orthodontist, otolaryngologist, pediatrician, etc.) when factors requiring co-intervention are identified.

Based on this data, the speech therapist It determines if atypical swallowing exists, what factors are maintaining it, and what therapeutic goals make sense for that specific person.

Treatment of atypical swallowing

The treatment of atypical swallowing is centered on orofacial myofunctional therapy, an approach that works on the strength, coordination, and balance of the muscles of the face, tongue, lips, and jaw, always applied to real functions such as breathing, chewing, and swallowing.

In general, the intervention plan includes:

• Correction of oral habits – Gradual and guided removal of pacifiers, fingers, and other objects the child puts in their mouth, as well as habits such as biting lips or cheeks.
• Nasal breathing technique – whenever possible, with medical assistance if there are obstructions, so that the person can breathe predominantly through the nose.
• Strengthening and coordination of the orofacial muscles – specific exercises for the tongue, lips and cheeks, integrated into functional and playful activities, especially for children.
• Retraining tongue posture – training the tongue's resting position on the palate and its correct action during swallowing.
• Chewing training – Progressive introduction of foods with different textures, bilateral and rhythmic chewing exercises, always adapted to age.
• Systematic training of the new swallowing technique. – repeated practice, with feedback, in saliva, water, and food, until the new pattern becomes automatic.

In many cases, myofunctional therapy is performed in parallel with orthodontic treatment. Working only on the teeth, without re-educating the function, increases the risk of relapse, that is, of the teeth shifting again due to unbalanced muscle forces.

Sessions can be in person or in a virtual format. Online speech therapy, provided that good observation conditions and family cooperation are guaranteed. The most important thing is the regularity of the sessions and the consistent practice of the exercises at home.

What can you do at home to help?

Even before the assessment, or while the follow-up is underway, there are several simple actions that the family can take to support the treatment of atypical swallowing. These do not replace professional intervention, but they reinforce the therapeutic gains.

Some useful strategies include:

• Ensure the child is properly supported at the table, with feet flat on the table and torso aligned;
• Offer age-appropriate foods with some variety of textures, avoiding excessively long feedings of very liquid or pasty purees;
• Avoid excessive distractions during meals (screens, constant toys), so that the child can feel their own body and the act of chewing and swallowing;
• Observe if the mouth is frequently open at rest and, if so, discuss this during the assessment;
• Avoid reinforcing habits like thumb sucking, shirt collar biting, or chewing on objects – and seek professional help to plan how to stop eating them.;
• Follow the guidelines and exercise plans sent by the speech therapist, transforming them into quick games integrated into your routine.

If you notice signs of straining, frequent choking, or persistent food refusal, it's important to share these observations during your consultation. In some cases, atypical swallowing occurs alongside other conditions, and early intervention can prevent bigger problems in the future.

When to seek help and which professional to consult.

Ideally, atypical swallowing should be identified and treated as early as possible, often in preschool or early school age. However, it is never “too late” to intervene: adolescents and adults also benefit from functional retraining.

It is advisable to seek evaluation when:

• Observe the tongue between the teeth when swallowing or at rest;
• There is very slow eating, fatigue when chewing, or refusal to eat more solid foods;
• There are significant dental changes or orthodontic treatment in progress;
• the child presents other associated signs, such as Mouth breathing persistent snoring or restless sleep;
• There is a history of frequent choking, recurrent respiratory infections, or more pronounced feeding difficulties;
• notice Children's speech problems that persist beyond what was expected.

A speech therapist is the appropriate professional to assess chewing, breathing, and swallowing function, as well as the impact on communication. In many situations, teamwork with an otolaryngologist, pediatrician, orthodontist, or other specialists is the most effective way to achieve stable results.

If you have questions about your child's overall communication and feeding development, you can also explore content about... Paediatric speech therapy and schedule an evaluation with a specialist.

Conclusion

Atypical swallowing is not "a phase" that always passes on its own, nor is it merely a matter of dental aesthetics. It is a functional alteration involving the tongue, lips, facial muscles, breathing, posture, and oral habits. When not identified and treated, it can contribute to dental problems, chewing difficulties, speech alterations, and impact quality of life.

On the other hand, when there is a careful assessment, a personalized intervention plan in Speech therapy With family collaboration, it is possible to retrain swallowing patterns, improve feeding efficiency, and promote more harmonious development.

If you recognized some of the signs described in this article in yourself or your child, the next step can be as simple as scheduling an evaluation with a speech therapist. The sooner you act, the easier it will be to change patterns, monitor growth, and prevent small changes today from becoming major challenges tomorrow.