How your child swallows shapes how they speak: the SLP's case for orofacial myofunctional therapy

By Yelena | Holistically Speaking Speech Therapy · Flower Mound, TX

Swallowing is one of the most frequent things the human body does — somewhere between 500 and 700 times a day, without conscious thought. For most people, it never becomes a subject of concern. But as a speech-language pathologist, swallowing is something I think about in nearly every session I have with a child — because how a child swallows tells me an enormous amount about how they're going to speak, breathe, and develop.This connection isn't intuitive. Parents usually come to me worried about sounds their child can't produce, words that aren't coming, or speech that's hard for others to understand. Swallowing is the last thing on their radar. But the muscles involved in swallowing are the same muscles involved in speech — and when those muscles are patterned incorrectly, it shows up in both places.

What proper swallowing actually involves

A correct swallow is a coordinated sequence: the tongue tip lifts to the roof of the mouth (the palate), the lips seal, and a wave of muscular movement carries food or liquid efficiently to the throat while the airway closes to protect it. This pattern, repeated thousands of times a day from infancy onward, does more than move food. It shapes the developing palate and jaw. It supports nasal breathing. It maintains the posture of the tongue at rest — which is one of the most important factors in how clearly a child will eventually speak.When that pattern goes wrong — most commonly through tongue thrusting, where the tongue pushes forward against or between the teeth during swallowing — the consequences ripple outward in ways that aren't always immediately obvious.

The speech connection

As an SLP, this is where I see the most direct clinical relevance. The tongue is the primary articulator in speech — it's responsible for the majority of the sounds in the English language. Its resting posture, its range of motion, and the patterns it has learned through thousands of daily swallows all directly influence how precisely it can move during speech production.Research published in peer-reviewed literature has consistently identified tongue thrusting, atypical swallowing, and orofacial muscle imbalance as underlying factors in disorders of articulation. A study examining orofacial myofunctional disorders in children found co-occurrence with speech sound disorders, particularly for sounds that require precise tongue placement — the /s/, /z/, /l/, /r/, /sh/, and /ch/ sounds that are among the most commonly affected in children who seek speech therapy.

When the tongue has spent years learning the wrong pattern, speech therapy alone — without addressing the underlying muscle function — is often treating the symptom rather than the source.

This is why I incorporate orofacial myofunctional assessment into my work with children who present with persistent articulation difficulties, especially when traditional speech therapy approaches haven't produced the expected gains. Sometimes the missing piece isn't more practice — it's retraining the underlying muscle pattern.

Beyond speech: what else atypical swallowing affects

Oral and facial development

The tongue exerts significant pressure on the palate with every swallow. Over time, correct tongue pressure helps shape a wide, well-formed palate and properly aligned dental arches. Tongue thrusting applies pressure in the wrong direction — forward against the teeth — contributing to open bite, crowded teeth, and a narrowed palate. Pediatric dentists and orthodontists increasingly recognize that correcting alignment without addressing the underlying muscle pattern often leads to relapse.

Breathing and airway health

Proper swallowing supports nasal breathing, which is the body's preferred respiratory pathway. Nasal breathing filters, warms, and humidifies air, supports healthy oxygen-carbon dioxide exchange, and produces nitric oxide that supports immune function. Mouth breathing — which frequently accompanies atypical swallowing patterns — bypasses all of this. In children, chronic mouth breathing is associated with disrupted sleep, reduced oxygenation during sleep, and in some cases obstructive sleep apnea. It also changes the resting posture of the jaw and tongue, compounding the original problem.

Posture and body tension

The jaw, neck, and shoulder muscles are closely interconnected. When a child habitually uses incorrect swallowing muscles, it can create chronic tension through the jaw and neck — affecting head posture and, over time, spinal alignment. This may seem like a stretch, but the fascia connecting these structures means that what happens in the mouth genuinely travels downward through the body.

Digestion

Efficient swallowing is also the gateway to efficient digestion. Children with atypical swallow patterns may take in excess air while eating, swallow inadequately chewed food, or have ongoing discomfort around mealtimes that leads to food avoidance or selective eating — a presentation I see often in children with sensory differences.

Signs worth paying attention to

Parents are often the first to notice something is off at mealtimes or during speech, even if they don't have a name for what they're seeing. Signs that may indicate an orofacial myofunctional disorder include:Mouth breathing at rest, during sleep, or during the dayTongue visible between the teeth during speech or swallowingDifficulty with certain speech sounds, particularly /s/, /z/, /l/, /r/, /sh/Open-mouth resting posture (lips don't naturally close)Messy eating, difficulty chewing, or prolonged mealtimesFrequent choking, gagging, or coughing during mealsSnoring or restless sleepProlonged thumb-sucking or pacifier use past age twoDental concerns like open bite, crowding, or frequent orthodontic relapse

What orofacial myofunctional therapy involves

Orofacial myofunctional therapy (OMT) is an evidence-based approach — within the scope of practice of speech-language pathologists — that retrains the muscles of the tongue, lips, and face to establish correct resting posture, nasal breathing, and swallowing patterns. ASHA recognizes OMT as part of the SLP's role in addressing orofacial myofunctional disorders, and a growing body of research supports its effectiveness.A systematic review of the literature found that across studies, OMT produced improvements in swallowing pattern, tongue position, lip closure, and nasal breathing. Importantly, research also suggests that OMT is most effective when integrated with other care — orthodontics, pediatric dentistry, and in my practice, the broader holistic support I provide for nervous system regulation and sensory development.Therapy itself involves targeted exercises — strengthening tongue elevation and lateralization, retraining lip seal, establishing nasal breathing habits, and building the awareness and control needed to change an automatic pattern that the body has been running for years. It takes consistency, and it takes time. But the results — clearer speech, better sleep, improved dental outcomes, easier mealtimes — are meaningful and lasting.

A whole-child perspective

In my practice, I never look at swallowing in isolation. A child with atypical swallowing patterns often also has retained primitive reflexes, sensory processing differences, or a nervous system that is working harder than it should be. These pieces are connected. Addressing one without considering the others is addressing a piece of a larger picture.This is the heart of what holistic speech therapy means to me — not just targeting the presenting symptom, but understanding the whole developmental landscape the child is navigating and supporting the conditions in which real change can happen.

If you're noticing signs of atypical swallowing, mouth breathing, or persistent speech sound difficulties in your child, I'd love to connect. I offer a free consultation for families in the Flower Mound and DFW area.

You might also find my posts on chronic stress and nervous system development and retained primitive reflexes helpful — these pieces of development are more connected than they might first appear.

References: ASHA Practice Portal. Orofacial Myofunctional Disorders. American Speech-Language-Hearing Association. · Holtmann, H., Vici, A., & Bohnert, K. (2017). Systematic review of myofunctional therapy for orofacial disorders. International Journal of Orofacial Myology, 43, 37–46. · Cunha, D.A. et al. (2022). Effectiveness of orofacial myofunctional therapy in improving orofacial function and oral habits: a scoping review. PMC. · Barbosa, et al. (2025). Effectiveness of OMT for speech sound disorders in children. MDPI.