sound practice in action
Posted by Glynnis Dubois on November 26, 2014 12:11 AM
I know that it may sound odd, but chewing and swallowing and speaking are so interrelated that they truly depend on each other. As with so many other developmental milestones, the ability to speak depends on other, earlier changes happening in the mouth. Just as children need to develop the muscle strength and coordination to crawl, climb and cruise before they can walk, a child’s mouth—specifically the tongue and jaw—needs to organize and develop the skills for biting, chewing and swallowing pieces of food before it is able to talk.
As I mentioned in a previous blog, when assessing a child for speech, I always ask about feeding (especially if they have unintelligible speech). So often when I ask how the child eats or if there are any concerns around feeding, the parents will tell me that the child overstuffs his/her mouth or that they “love to eat” but just seem to swallow the food. The most common one is that the child will only eat certain textures of soft, easily-swallowed foods such as pasta and yogurt. Other parents tell me that their child often gags or vomits when eating and that it seems to be due to the food’s texture, especially if there are any lumps in it (e.g. pieces of fruit in the yogurt).
These little clues give me insight into what is happening in the child’s mouth so that, independent of the child’s chronological age, I have a better idea of how mature his/her mouth development actually is.
When talking about how the mouth develops skills, we often take for granted the process by which a mouth reaches the ability to speak. We know all about how the child listens for months and months before we get any word approximations and that even then it takes a number of years for a child to develop the ability to clearly say all speech sounds.
When we see a child who, in our minds, should be speaking clearly but is not, we need to investigate to make sure that all the background work had the chance to be completed. Do they have the ability to bite, chew and swallow efficiently, effectively and in a timely fashion? This may seem to be a tall order when you think of all that needs to happen in order to do this.
Fine motor development in the mouth is something that is quite a miracle, yet imperative to survival.
Just as other parts of our bodies move through the slow and arduous development of muscle strength and coordination, so do the muscles of the tongue, jaw and soft palate. In order to make sounds in the back of your mouth (/g/, /k/), or even nasal sounds (/n/, /m/), you have to be aware of the ability to raise and lower your soft palate. This takes practice and we hear babies cooing at a very young age in order to practice this. Later comes some bilabial sounds; ‘raspberries’ and /b/ —sometimes changing to the engagement of the tongue for the other kind of ‘raspberries’ where the tongue is between the lips.
This is usually around the time when complementary foods are introduced to babies in purée form.
The skill that needs to be developed here is moving a semi-solid food off a spoon and transferring it from the front to the back of the mouth in order to swallow the bolus (ball of food) as a whole. This progression is often where we run into problems as many people think that the next food is a lumpy purée.
The next step is actually thicker purées because this encourages the tongue to work a little harder to move that bolus back and keep it intact which, of course, takes coordination of the tongue’s posture. By ‘posture’ I mean that the tongue needs to keep the bolus in the centre of the tongue, not letting it break apart to spread all around the mouth and into the buccal spaces (cheek pockets), or worse, down the throat before the baby is ready to swallow it. This is quite a sophisticated task as you can well imagine.
After this, the tongue must figure out how to move items from the centre of the tongue onto the gum ridge (or teeth if they are present) to prepare for chewing.
The next step is the process of biting pieces of food and figuring out how much jaw pressure to put on the different types of food offered. This again is a challenge as one has to put enough pressure to break a piece off but not too much pressure (which would hurt).
After this is mastered, the baby must decide what to do with this piece of food that is now in his/ her mouth. If the tongue has not developed the skill to move the piece onto the gum ridge, the food is pushed out by the tongue (this is due to the extrusion reflex —which tells us that the mouth is not yet ready for pieces of food, nor is it safe). If the child has had the chance to practice and develop the skill, the piece of food will quickly be pushed laterally by the tongue and held on the gums (or teeth) and chewing will begin.
This very long and arduous process brings us back to the task of speaking—I know, you thought that I was never going to get there! In order to have all of those wonderful fine motor abilities that are needed for producing the speech sounds, a child must first have all of those fine motor abilities for biting, laterally moving and then chewing their food.
As you know, speech sounds require coordination of the jaw, tongue and lips as well as breathing (not by any means downplaying the importance of cognitive function) in order for them to be produced in a manner that can be understood by others.
As you can appreciate, the stepping stones to speech must be mastered in an organized fashion and that the mouth, especially the tongue, must be given the time and practice to learn and build confidence in the areas around feeding in order to move on to the daunting task of producing all of those amazing sounds that culminate in the art of trying to make oneself understood in the clear and precise manner that we call ‘talking’.
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KAREN MACIVER LUX