Ask: Why is swallowing pattern important?

Q: My 7-year-old’s dentist said that he has a tongue thrust swallow and that may be why his teeth are crooked, why he chokes sometimes during eating and why his speech is hard to understand. The dentist recommended that we see a speech pathologist who works on tongue thrust therapy. Would this help?

A: It sounds like your son has a tongue thrust (oral myofunctional swallow pattern), which is an incorrect tongue pattern for eating, resting and talking. An oral myofunctional swallow pattern (or tongue thrust swallow) is characterized by the tongue coming forward toward the teeth instead of elevating to behind the teeth (on the alveolar ridge) when swallowing. The pressure of the tongue against the teeth can cause crooked teeth. If your dentist had not already identified the tongue thrust swallow, the easiest way to check this at home is to swallow a spoonful of pudding while smiling (so as not to activate the lips, which should not be active when swallowing) and observe what happens. If there is pudding on the front teeth or pudding is squirted out of the front or side teeth, the tongue is moving incorrectly during swallowing. Chocolate pudding works best because of the contrast of the pudding against the teeth.  

Incorrect tongue patterns need to be corrected as they can have multiple impacts on a person’s health, the health of their teeth and social/emotional development.

It appears that in the case of your son, the oral myofunctional swallow pattern has negatively impacted his ability to chew and swallow foods safely. Correct tongue patterns are necessary to completely chew foods in preparation for swallowing and to transit the food safely into the throat and stomach. Incompletely chewed foods are harder to swallow and are more likely to get stuck or obstruct the airway, which may be why he chokes while eating. It is also important for your child’s safety and emotional development. Many children that we see start to avoid social opportunities because of embarrassment of their eating and choking episodes.

Eighty-one percent of people with an oral myofunctional swallow pattern have difficulty producing sounds that require tongue tip elevation such as s, z, sh, zh, ch, j, t, d, n, r, or l. These speech errors are stubborn, and if the speech pathologist does not recognize and change the oral myofunctional swallow pattern, the speech errors may not correct despite years of speech therapy. Remediation of these speech errors relies on changing the incorrect tongue patterns.

Based on the information you provided, I feel that oral myofunctional/feeding therapy would be helpful to your child. Make sure that you interview the speech pathologist that you choose to make sure that they have the knowledge and skills to help your child. In addition to the misaligned teeth that your dentist observed, the following are other characteristics that a child with a tongue thrust swallow may exhibit:

  • Mouth breathing
  • Open mouth or lips at rest
  • Has difficulty swallowing certain foods
  • Activates lips when swallowing
  • Places too much food in mouth
  • Takes inappropriate bite size
  • Chews with mouth open
  • Difficulty chewing
  • Fast or slow eating
  • Uses liquids to “wash down food”
  • Burps frequently
  • Is a messy eater
  • Is a picky eater
  • Chokes/coughs/gags/vomits during feeding


Things that can maintain or make it difficult to change an oral myofunctional swallow pattern include:

· Oral habits: Finger or thumb sucking, blanket or shirt sucking, nail biting

· Use of spouted sippy cups or extended use of bottles

· Airway issues such as enlarged tonsils and adenoids, allergies, intolerances

· Teeth grinding or clenching


  If you have a question about your child's health or happiness,  ask Joan or any of our experts by sending email to .



Joan Dietrich Comrie of Carolina Pediatric Dysphagia (919-877-9800) has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia. She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986. Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington, Ky., Vanderbilt Medical Center, Nashville, Tenn., and WakeMed, Raleigh) where she developed or reorganized the hospital's pediatric dysphagia program.

Joan has spoken on the topic of pediatric dysphagia nationally and internationally. She has published in a professional journal.  She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed. She has served as chairman and member of a subcommittee of the Special Interest Division 13 of the American Speech Language Hearing Association (ASHA). She has received her certificate of clinical competence (CCC) through ASHA and is licensed in the state of North Carolina.