The Swallowing Secret: How Your Child Swallows 600 Times a Day Shapes Their Face

Here is a number that surprises most parents: your child swallows roughly 600 times every day. That's not a typo. Most of those swallows are completely automatic — saliva swallows that happen during conversation, during sleep, during moments of stillness that barely register consciously. The average is approximately one swallow per minute during waking hours, with additional swallows during and after eating.

Now consider this: every one of those 600 swallows either reinforces a correct tongue posture or perpetuates a tongue thrust. Multiplied across months and years of childhood, the cumulative mechanical effect on developing teeth, dental arches, and facial bone structure is not trivial. It is measurable, documented, and — crucially — addressable if caught early enough.

What Happens During a Correct Swallow

A correct swallow is a precisely sequenced neuromuscular event. The tongue tip rises to contact the alveolar ridge (the firm ridge just behind the upper front teeth), the tongue body seals against the palate, the soft palate rises to close off the nasal passages, and a wave of tongue pressure moves backward to propel the bolus toward the throat. Throughout this sequence, the teeth come lightly together and the lips remain gently closed.

The whole event takes about one second. From the outside, it is nearly invisible — a slight throat movement, maybe a subtle chin shift. No tongue should be visible. No chin muscles should tighten and wrinkle. No lip or jaw strain should be apparent.

What Happens During a Tongue Thrust Swallow

In a tongue thrust swallow, the sequence breaks down at the initiation phase. Instead of elevating to the alveolar ridge, the tongue moves forward — pressing against the inside of the upper or lower front teeth, or pushing directly between the teeth as the jaw remains slightly open. The lips may press together tightly to compensate for the lack of tongue seal. The chin muscles often visibly tighten and dimple.

Hanson (1976) was among the first to systematically document the dental and speech consequences of persistent tongue thrust, estimating the force applied by the tongue against the front teeth during a thrust swallow at significant levels — and emphasizing that the sheer frequency of swallowing was what made even modest per-swallow pressure clinically important over time.

The Cumulative Effect on Dental Arch and Facial Growth

The craniofacial complex is remarkably plastic during childhood. Bone responds to the forces placed on it — a principle called Wolff's Law in orthopedics. This plasticity is a feature, not a bug: it's what allows orthodontic appliances to work, and what allows orofacial myofunctional therapy to reshape growth trajectories when the habit is corrected early enough.

The documented consequences of chronic tongue thrust on the developing dentition include:

• Anterior open bite: The space between upper and lower front teeth that develops when the tongue routinely prevents them from occluding. An open bite that closes when the tongue is held back from the teeth is a strong diagnostic indicator of tongue thrust as the cause.
• Upper incisor protrusion: Forward flaring of the upper front teeth driven by persistent lingual pressure against their palatal surfaces.
• Narrowed palatal arch: When the tongue rests low in the mouth rather than against the palate, it fails to provide the outward lateral pressure that shapes the palate's width. This can contribute to a high, narrow palate — which in turn can contribute to nasal airway restriction and mouth breathing.
• Facial elongation: Mouth breathing associated with tongue thrust and low tongue posture can alter the vertical growth pattern of the face, contributing to a longer lower face height in severe cases.

Proffit and Mason (1975) laid out the biomechanical case for myofunctional therapy as a complement to orthodontic treatment, emphasizing that correcting the muscle habit was necessary to prevent relapse of dental corrections — because as long as the swallow pattern remained unchanged, the teeth would continue to be pushed back toward the thrust position.

How to Identify a Tongue Thrust Swallow at Home

You don't need clinical training to observe the basics. Here's what to watch for:

• Watch the chin. A correct swallow has a smooth, subtle chin movement. A thrust swallow often produces visible chin muscle dimpling or tightening as the mentalis muscle compensates for inadequate lip seal.
• Watch the lips. Do they press together hard? Do they separate slightly during the swallow? Either can indicate compensatory muscle activation around an incorrect tongue position.
• Watch the throat. A correct swallow initiates with tongue elevation and a throat movement. A thrust swallow may show a pause, a forward jaw movement, or visible effort before the throat moves.
• Watch from the front. Give your child a small sip of water. Can you see the tip of their tongue anywhere near or between the front teeth during the swallow?

Teaching the Correct Swallow

ASHA's Orofacial Myofunctional Disorders Practice Portal outlines the evidence base for structured swallow retraining. The process is not simply telling a child to "swallow differently" — the swallow is an automatic reflex that requires deliberate motor retraining to change. The classic sequence taught in myofunctional therapy involves:

1. Establish the resting tongue position first. Before training the swallow, the child learns to rest the tongue tip at the "spot" — the alveolar ridge — as a default resting posture. This resets the starting position from which the swallow initiates.
2. Practice the tongue-up initiation in isolation. Touch the spot, feel the tongue seal against the palate, practice the elevation without the full swallow.
3. Add the swallow with awareness. Using water or saliva, deliberately swallow with the tongue starting from the correct position, teeth lightly together, with monitoring in a mirror.
4. Build automaticity through high-volume repetition. Villa et al. (2017) emphasize that the transition from conscious practice to automatic habitual swallowing requires significant repetition across weeks — not just occasional reminders.

The encouraging news for parents is that childhood is the ideal time to address this. The same bone plasticity that makes the dental consequences progressive also means that correcting the pattern during the growth years can redirect the trajectory. A child who learns a correct swallow at age 6 gives their developing dentition years of correctly directed force — roughly 219,000 correct swallows per year instead of 219,000 thrust swallows.

References

1. Hanson, M. L. (1976). Tongue thrust: a point of view. Journal of Speech and Hearing Disorders, 41(2), 172–184.
2. Villa, M. P., Evangelisti, M., Martella, S., Barreto, M., & Rizzoli, A. (2017). Orofacial myofunctional therapy in children with obstructive sleep apnea. Sleep Medicine, 36, 84–88. PMC8343673.
3. Proffit, W. R., & Mason, R. M. (1975). Myofunctional therapy for tongue-thrusting: background and recommendations. Journal of the American Dental Association, 90(2), 403–411.
4. ASHA. Orofacial Myofunctional Disorders Practice Portal. American Speech-Language-Hearing Association.