We’ve been looking at the four domains of feeding we consider in our initial assessment. Last week we covered some of the ‘psychosocial’ factors, this week we’ll start looking at ‘feeding skills’.
Feeding Skills
Eating and drinking is complex! Each swallow involves 32 pairs of muscles supplied by 7 cranial nerves. Kids also need to develop the gross motor skills to ensure the right body position for feeding, and the fine motor skills to feed themselves and use utensils. Phew… that’s a lot! Children need to build these skills to eat the kinds of food and drink appropriate for their age.
Over the next few weeks, we’ll be looking at all the structures we use for eating and drinking.
Let’s start with the tongue.
Early on, between 0 and 4 months, babies suckle using a forward and backward tongue reflex to draw milk from a nipple or bottle.
Between 4 and 6 months, babies learn to suck using an up and down movement.
Between 6 and 7 months, children begin to move their tongue laterally, or side to side. This coincides with the time that most children are ready to start solid food – side to side tongue movement is important for moving food around our mouths and get it ready to swallow.
As they grow children’s tongue lateralisation improves, and movements become more coordinated
So…how do we move our tongue?
The movements of our tongue are controlled by one of our cranial nerves – cranial nerve 12, or the ‘hypoglossal nerve’. There is always an exception though, one tongue muscle pair is controlled by the pharyngeal plexus cranial nerve.
Cranial nerves flow from the brain to structures in our head and neck to control movement; these structures then communicate sensory information back to the brain.
We have 4 pairs of intrinsic tongue muscles and 4 pairs of extrinsic tongue muscles. The intrinsic muscles change the shape of our tongue (think of people you know who can roll their tongue!), and the extrinsic muscles change the position of the tongue (these muscles help you stick your tongue out or reach that bit of food stuck at the back of your teeth!).
What about sensation?
Our tongue is hugely important for sensation; it tells us what food and drink tastes and feels like. This sensory information is important as our swallow adapts to the food and drink by telling us whether we are consuming fast moving cold water, a teaspoon of smooth yoghurt, or a big bite of hamburger.
Depending on the part of the tongue and the type of sensation (taste or tactile, i.e. location and texture) sensory information is interpreted by different cranial nerves and messages sent to the brain.
Why is our tongue important for eating and drinking?
Your tongue helps to keep food or drink in your mouth until you are ready to swallow.
Your tongue pushes food in between your teeth and moves it around your mouth so you can chew the food effectively.
Your tongue helps to move food from your mouth into your throat.
If any bits of food are left behind, your tongue allows you to ‘sweep’ in between your teeth and cheek to remove any bits of food.
During our initial assessment we look at how the tongue moves and watch during eating and drinking to check current feeding skill development. We check for tongue tie and if this is impacting too.