Chewing Patterns Matter More Than Picky Eating

If a three year old is still munching right, straight up and down, up and down, up and down, or they're pocketing food in their cheeks, that, my friends, is a sign that we need to intervene. It means the system has not fully matured and it's time for a feeding evaluation. Let's talk about the one milestone that changes everything in feeding. But somehow no one teaches it in grad school, and many people seem to be missing it in their courses as well. What is it? Chewing. Most clinicians can tell you when a baby should babble or when they should crawl. But if you ask them when, like that rotary chew should emerge. Crickets. Absolute crickets. So today we're going to dive into the four stages of chewing development. How they connect to feeding milestones, what to look for clinically, and when we should start to get concerned. So let's first talk about, like, why chewing development even matters. Because chewing isn't just about eating solid food, right? It's about function, airway development, and it's going to build strength, tongue control, coordination for speech and swallowing and breathing. And when we miss this window, we often see kids who can't manage textures. They might gag easily. They may rely on soft foods for a really long time. Too long, arguably. And so I just want to highlight a couple things for you. Right? So the first thing I want to highlight is that chewing drives orofacial and airway growth. It is essential for proper jaw and palate development. Right? If we have delayed chewing, right. That leads to delayed oral motor maturity and potentially a feeding aversion. And so our chewing milestones that we're going to talk about soon help us gauge our readiness for solids, draw, drink, drinking, and eventually even like the speech sounds we should be expecting. You can't build that circular rotary chew pattern on a weak, unstable base. The base for me, being like the jaw, okay? And the muscles that support the jaw stability drives mobility here. So if you've ever wondered, like, why your toddler or the kid that you're working with still is mashing food with their tongue, right? They're putting food between the tongue and the palate and they're just mash, mash, mash, I'm moving the wrong side. Mash, mash, mash, mash, mashing, right? This episode is going to help you connect this the dots. So let's dive in further.

Welcome to the Untethered podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway tether, dural tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. And if you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest. Posture.

Tongue up, lips closed, teeth apart. Breathe through your nose.

Let's get started.

I want to break down the progression of the four stages of chewing development from the early like munches to that full rotary too. Because I see too often that people go for the full rotary tune. I'm like, wait, wait, hold on a second. Like we forgot about all the other necessary milestones and skills, skills that we need to develop that too. We can't just go from not having it to having it. We gotta, you know, there's a couple phases, a couple things happen in between. So number one is a phasic bite reflex that is present in the first about six months of life. And it's a reflexive vertical jaw movement, like an up and down jaw movement. There's no voluntary chewing yet, right? So it's reflexive. The breast or bottle nipple goes in and that jaw is moving up and down. And a tongue should be doing a sucks while follow breathe pattern. But we're going to focus on chewing. So ignore that. Let's, let's follow breathe for a moment. So if you were to go in and like put your finger on the baby's thumb, you might stimulate it. They might kind of close their, their, you know, jaw lightly. They're not going to clench down necessarily, but it's that reflexive movement that starts up and down, up and down, up and down. You're watching it keep moving the wrong palate, I mean to move the bottom one, the mandible. So this is typically seen as well when babies are learning to mouth toys. Early teethers, you know, they exploring intraorally. And this is really important because it helps to strengthen the jaw and prime the oral musculature for what's to come, right? So you're going to see those up and down movements only there's not going to be any lateral side to side motion yet. And clinically this sets the stage for the munching phase. And so it just looks like, like I said, up, down, up, down, almost like chomping. If you Will, this is a really good time to introduce, you know, meltables, dissolvable solids for safe practice and things. But you know, depending on who you talk to, it's also a really good time to give baby, you know, maybe give them a big. As we introduce texture through foods that are not just liquid. Right. So the vertical munching pattern between six to nine months, where that jaw, you know, that's the first voluntary chew pattern. It's just that simple open and close of the jaw, up, down, up, down. Right. And it's really common as babies begin purees, you know, to soft solids. Even for babies following like a modified baby led weaning program or baby led weaning where they may be biting on hard things, you know, with supervision again, you're going to get that up and down jaw movement pattern. And arguably it's really good when you have those harder things for the jaw development. But we don't have to go there. So the tongue is going to stay mostly midline at this point with not. We're not going to see that side to side movement. Some people are giving, you know, steak bones like the big ones, you're not going to break. The baby's not going to break a piece off of under supervision or steak on a bone or a hard carrot or a hard piece of celery, something the baby's not going to break anything off of. But you're going to supervise just in case because it is really, really beneficial for jaw development and the masseter development and all those surrounding muscles to have this experience when the baby is voluntarily chewing up and down, up and down, up and down. But again, depends who you talk to. Okay, the diagonal chew pattern is next. That's number three. Right. So first was our basic bite reflex. Second is our vertical munch pattern. And third is our diagonal two pattern. And then fourth, we finally get to the rotary two. So for the diagonal two, number three. Right. This is usually about nine to 15 months or so, the jaw begin to move diagonally. Okay. So the tongue actually starts to shift food from side to side, but it's usually staying more to one side. And this is like where true chewing starts to emerge. Because the baby's going to use a lateral tongue motion and move this food over to the molars or to the teeth or to the gums. And then they're going to also bring their jaw over and up to the midline, down, over, up to midline, but we're not crossing the yet. Okay. That's why it's just a Diagonal down, across and up and around. Right up but not around yet. So some people might start here with like softer fruits, veggies, small bites of pasta or meatballs to kind of play with this and have them have good success in this stage. Or even just like little pieces of cut up like cubed chicken or steak or something that's a little more chewy clinically. Right. This is a phase where some kids get stuck. Reading about feeding is one thing, seeing it is another. Inside screen the peds to feed the peeds my free three day training. You'll watch real feeding screenings and lear exactly what to look for. No overwhelm, no guesswork, just clarity. Save your spot@feedthepedes.com backslash training. If they're not exposed properly, if they kind of, they might stay in the vertical and not actually move into. Sorry, yes. They may get stuck before they enter this stage is what I meant to say. They may get stuck in the vertical chew. The last stage we talked about that munch, that up and down munching pattern and they may not actually move into that diagonal coordination that, you know, diagonal two pattern. So a lot of the kids that we see typically are stuck in that munch two pattern. Okay, just so you're, just so you're aware. Now, number four is that rotary two pattern that we start to see between 15 to 36 months. Big range. But like by three years of age they should have mastered that circular rotary to that mature chewing pattern where the jaw moves in a very clear circular. And if you're on YouTube, you can see this, a very clear, you know, food goes in, they might move it to one side, chew, chew, or moving it around or chewing or moving it around the tongue. Right. And where the jaw is crossing this line here and moving in what looks like almost a circle one way or the other. And so what's happening here is that the tongue in the jar are working in sync to break down tougher foods more efficiently. And the child can chew on both sides. They can move the bolus around. The bolus again is just the chewed up food mixed with saliva. They can manage mixed textures. And this stage supports advanced feeding skills. Right. And at this point, you're probably going to have a more, you know, start to have clearer articulation closer to three than you did at two, for example. Right. You're not completely clear at three. It's usually about 75% intelligible. But as your oral motor skills advance, so do your other skills like your speech sound development skills. So if a three Year old is still munching, right? Straight up and down, up and down, up and down, or they're pocketing food in their cheeks. That, my friends, is a sign that we need to intervene. It means the system has not fully matured and it's time for a feeding evaluation. So I like to run through that because there's so much confusion around the four stages of chewing development. And so hopefully that phasic bite reflux into a vertical munch pattern, into a diagonal two pattern, into the rotary two pattern, hopefully that helped to kind of break that down and make that really, really clear. But here's what, here's where most therapists then, you know, and even parents miss the connection. Okay. The bottle to solid transition is really a chewing transition. The jaw and the tongue, right? They need stability before they can handle new textures. And so that's why I like prolong bottle use can actually delay chewing. Babies who never learn efficient sucks, swallow, breathe patterns also tend to struggle to coordinate the chew, swallow, breathe pattern. And early introduction of appropriate textures. Around six months, depending on like readiness cues is going to help promote jaw and tongue dissociation. I kind of spoke about that a little bit. So what I want you to clinically watch for here is if there's like, there's no tongue lateralization past 10 to 12 months, they're relying on, you know, mouthing foods in the front and just kind of like munching. There's persistent gagging at times or even choking on lumpy textures. Usually it's more of a gagging than it is a choking, fatiguing while eating or pocketing food. Right. These, these are not picky eaters. These are the kids who have missed key oral motor milestones. And a lot of them might be flagged as picky eaters by their parents because they become picky as to which food they'll accept because of these things that we need to be watching for clinically. Right. These skills that they just haven't develop, developed. Is that always the case? No. Is it the case a lot of the times in the kids that, that we see. And so the good news is that you can address this through functional feeding therapy. Right. I want to talk really quick again. I just want to like review the age expectations and any red flags to look for. Okay, so let's talk about what's typical again and when to go deeper. And so age milestones really quickly. Zero to six months, that's when we want that reflexive bite. Okay, I'm kind of reviewing here six to nine months is when we want that voluntary vertical to a vertical munch. Right. That chewing pattern. Then at nine to 15 months, we want the diagonal chew to develop. And then around 15 to 36 months, the rotary chew should be established. Okay. And so if you're not seeing the following things that I'm going to share with you, these are signs that we need to look into this further. So what are those signs? No munching by eight to nine months, there's still vertical chewing only past 16 months. Right. They've got that up and down chewy pattern only. And they're now 16 months old. They're gagging or choking with solids beyond the early learning phase. Like, they're no longer new to them. Right. And most often, again, like I said, gagging is going to be more common. Choking will be less common. Choking is like face is turning blue, they can't breathe. They can't. They're not audible. They can't make any noise because they literally cannot breathe. Their airway is completely blocked. Versus gagging is where they start to become a little like, you know, you'll hear them, it's audible. They don't like what's happening. Something's triggering their gag reflex. Maybe the food comes back out. That's a bit more common. And so I like to kind of highlight the difference. If the tongue is thrusting out, like pushing food out, repetitive, repeatedly, persistently. If there's difficulty transitioning textures or the only chewing on one side, that's a big one. And then if mouth is open when they're chewing or they don't have a great lip seal, that's another thing too. Okay. Because these signs are all telling us that there's a breakdown in strength instability or in coordination or all of the above. And so it's our job to go in there as feeding therapists and figure out, like, where that breakdown lives. Like, what is the root cause of all of this? Right. I recently had a two and a half year old that I was looking at who could really only manage crackers and pouches. No proteins, no mixed textures. And when he was assessed, he had really good speech clarity, actually at two and a half, but no rotary chew. Everything was that vertical, you know, and it wasn't even really the munch. He was actually mashing the food between his tongue and his palate. And within a few sessions of, like, targeted functional chewing work, think like food play, lateralization, jog reigning, he started to actually, like, manage ground meats and soft veggies a little bit easier to manage than like your Grilled meats. Right? And the, the secret wasn't sensory. It was motor. It was motor. Now you can't really separate sensory from motor. Right? I always, I believe both are at play most of the time. However, there was a big motor component here and that's why understanding the chewing progression changes everything about how you assess and how you treat. So next time you see a child who's stuck on soft textures or they're pocketing food, I want you to look behind, you know, beyond that behavior that's surface level and ask like what's happening with their two pattern, Are they vertical, diagonal or rotary? And if you want to see like real video example video examples of these two stages and like learn how to assess them clinically. I got you. Because we, we, we were asked by so many students in the past to like just have more examples of this. So we have them inside fe peds and Feed the Peeds opens in like a week. So inside, I believe it's module three. We break down chewing, development, assessment, treatment step by step. We have like actual case footage of like chewing and what it should look like. And so anywho, go to feedthepedes.com join the wait list. Get a sneak peek, you know, into when you join us in our free training that we're doing. You'll also get like a sneak peek into all of this as well. So eat the peas.com is where it's at. Because here's the thing, right? Understanding two patterns isn't optional. If you work in pediatric feeding, it's foundational. Like what are you even doing if you're not working on this? So that, my friends, is where it's at. I cannot wait to see you inside. Be the peas if you haven't already taken our course. If you have. Amazing. I hope that this was a good refresh for you and that's that. We'll see you inside.

Quick Disclaimer all information, content and material of this podcast are the opinions that of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Thanks for listening to this podcast. If you found value in this episode.

And want to hear more of these.

Myotots, airway and feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halibalkin.com or pop over to Hollybulcan on Instagram to get all the latest updates.