Swallowing

Anatomy and Physiology Related

to Pediatric Feeding Disorders
• Introduction
• Overview of Structures
-Lips, Teeth, Tongue, Palate, Larynx
Esophagus, Lungs
• Phases of Swallowing
-Oral Preparatory Phase, Oral Phase
Pharyngeal Phase, Esophageal Phase
 Dysphagia

• Breakdown in any of the phases of

normal swallowing  dysphagia.

• Breakdown in any of the sensory or

motor events which comprise the oral
preparatory, oral and pharyngeal stages
of swallowing.
 A Few Definitions
• Feeding: Generally considered the act
of getting the food from the cup, dish or
bowl to the mouth
• Swallowing: Generally considered the
next step. After the food gets to the
mouth, the swallowing process includes
preparing the food to be swallowed,
moving it to the back of the mouth and
triggering the swallow
Overview of Structures
 Introduction
• People swallow 600-800 times per day
• Purposes: Eliminates nasal mucous,
saliva and food
• Feeding and swallowing (as related to
nutrition) affect our ability to concentrate
and learn
 Lips
• Removes food from spoon, and liquid
from cup
• Need adequate ability to move (range of
motion)
• Need adequate strength
• Need ability to maintain closure while
chewing and swallowing
 Lip Movements
• Part 1: Chew an animal cracker. Watch
someone else do the same, or watch
yourself in the mirror.
– Observe: What are the lips doing? How are
they doing it?
• Part 2: Now, take another bite, pretend
that the lips aren’t working very well.
– You might notice they are very weak or
they don’t close.
 Teeth
• Need to adequately chew food
• If food is not chewed, choking may occur
• Nutrients may not be adequately broken
down and used by the body if not properly
chewed and broken down first
(masticated)
• If not cared for can lead to drooling
• Poor jaw alignment may impact feeding
 Tongue
• Needs adequate strength to break down
foods, transfer foods, and maintain
control of foods
• Needs adequate range of motion to
clear oral cavity
• Needs stamina to maintain strength and
agility throughout a meal
 Cheeks
• There are many muscle groups in the
cheeks
• In feeding they help to control the liquid
and food in the mouth
• If the cheeks do not work properly, food
can fall into the lateral sulci (between the
outer gums and cheek walls) If the
tongue is not working either, the food
and nutrients cannot be retrieved
 Soft Palate
• Elevates at the point of the swallow to
prevent nasal reflux
• If cleft, there is no prevention for the nose
• Lost food means lost nutrients
• Nasal obstruction may prevent palate
from closing properly; may cause
difficulty maintaining a closed mouth
posture and mean a potential loss of
food/nutrients
 Larynx
• PROTECTS AIRWAY
• Epiglottis flips over the larynx
• Vocal folds close over the trachea
(windpipe)
• Larynx elevates to allow food to pass
into the esophagus
 Esophagus
• Hollow muscular tube with sphincters at
each end: peristalsis moves that food
down
• UES-Upper Esophageal Sphincter:
muscle that opens to the pathway from
larynx to stomach
• LES-Lower Esophageal Sphincter:
muscle that opens from the esophagus
to the small intestine
 Lungs
• Not important in swallowing itself
• If food is not swallowed properly and gets into
the trachea and lungs, pneumonia can result
• “Aspiration is the action of material
penetrating the larynx and entering the airway
below the true vocal folds” (Logemann, 1983)
• Aspiration can generally be seen in the right
lower lobe on an x-ray of the lung
 Aspiration:
Signs and Symptoms
• Fever spike five minutes after the
episode
• Coughing
• “Wet” voice quality
• Medical history of frequent upper
respiratory infections / pneumonias
• Weight loss
 Oral Preparatory Phase
• Lip closure
• Cheek tone
• Rotary and lateral jaw movement
• Rotary and lateral tongue movement
• Anterior bulging of the soft palate
• Tongue forms a bolus with the food
 Oral Phase
• Bolus is held between the tongue and
palate
• Tongue pushes bolus to the back of the
mouth
• Tongue elevates and retracts squeezing
the bolus along the palate
• If tongue control is poor, food may go
into pharynx (throat) and be aspirated
 Pharyngeal Phase
• When food reaches anterior faucial
pillars, the pharyngeal phase is
triggered
• Velum (soft palate) closes
• Larynx elevates (epiglottis flips, true and
false vocal folds slam together)
• Tongue has a major role in triggering
the swallow
Practice Feeling for the Swallow
• Use 4 fingers on the neck to feel for the
swallow
• Under chin (above the bone)
• Bottom of the bone
• Top and bottom of the thyroid cartilage
• Normally should take 1-2 seconds
 Esophageal Phase
• Begins when the UES opens and the
food is transferred to the esophagus
• Peristaltic action pushes the food down
into the stomach
• This phase lasts 8-20 seconds
• Ends when the LES opens and the food
is passed into the stomach
 Therapy

• Medication
• Surgery
• BRAT
• Oromotor exercises