Episode 181: The 4 Types of Chew Patterns In Pediatric Development

Hi and welcome to episode 181 of the Untethered Podcast. It's your host, Hallie Balkan, and I promise we will bring guests back starting next week. But I wanted to join you for one more episode today to talk about a topic that has come up a lot, both in my programs, my courses as well as my membership, and in my free training that I've been doing over this past week. So. So let's jump in real quick. Want to let you know that doors to feed the peds are open right now, so if you go to www.feedthepedes.com you will see all you need to know about joining us. Doors will close on September 23, 2022 at midnight Eastern time, so do not miss the boat. This is the last course of this year and I have not set the schedule for 2023 yet, so be sure to join us if you have any questions at all. You also can email us@supporteedthepedes.com and we'd be happy to help you figure out how to get into the course if the course is right for you. And oh by the way, if you are a clinical fellow, you get an automatic 50% scholarship. You'll need to email us that for that as well. Now let's jump in. Quick Disclaimer all information, content and material of this podcast are the opinions 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 of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist 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, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Okay, so what do we want to talk about today? Well, it's come up quite a bit in doing the free training which by the way, if you missed the free training, the live training last week, it is recorded. The recordings will also be Left up until September 23rd Friday, September 23rd at 5pm Eastern Time and then they will come down. To access those recordings you do need to register, you need to go to www.feedthepedes.comtraining and that will you to the page, a screening page where we have all of the recordings uploaded and everything else you need to know. But as I just mentioned, if you want to join the course, doors are open now through September 23rd at midnight eastern time at www.feedthepedes.com. so join us there. All right, so let's jump in. I want to talk about choo choo choo chewing. I would go choo choo the choo choo train. No, let's talk about chewing. Um, this is something that, it's like this elusive topic that seems to confuse a lot of therapists. And so I figured, you know, I know we've talked about chewing on the podcast, but I wanted to address it directly. And I wanted to talk about what we typically see during oral motor development in regards to the jaw and how we move from a phasic bite that we should have at birth. You know, it's a phase. There's a phase phasic bite reflex. And into our munch chew into a diagonal chew, which is debatable depending on who you talk to. And then into our circular rotary chew, which evolves during infancy and progresses into toddlerhood. Ultimately, we should have an adult like rotary chew by around 36 months of age. So really interesting because again, depending on who you talk to, that changes sometimes. This conversation. Someone actually said to me, they, that they, they had a instructor in a myofunctional therapy course tell them that we don't develop a Rotary 2 until like 7 years of age and we don't need to be concerned about it until then. I'm here to tell you that based on what I know is feeding therapists, based on the research, based on the texts, based on the thousands of patients that many of us have worked with, based on traditional development, what we see in traditional development and, and even delayed development. That is not true. We should see in a typically developing child a circular rotary to develop by the time they are 30, a child is 36 months of age or 3 years old. Okay. Obviously there's gonna. There could be some. Not delay, but there could be a little wiggle room on either side of any milestone. But it's a pretty wide milestone window in which it starts developing into the point in which it should be in place. So we'll talk about these different types of chews, but I wanted to, like, give that little disclaimer first. So what is the phasic bite reflex? Well, this is something that is present between, you know, like birth to 6 months of age or so. And there are certain reflexes that should definitely integrate at a certain time. Some may Say that this, this reflux, you know, will integrate between 9 to 12 months of age. Others say that it's really primarily present during the first six months of age. Regard. Regardless, the phasic bite reflex is basically when the jaw, when the baby opens and closes their jaw based on pressure applied to the gums. So let's say like, think about the future molar area where future molars will grow. And if you take your finger pad and you push down on that, that gum region, I'm demonstrating on video, like you guys can all see this, this will be on YouTube eventually. If you push down on the gums, what that does is it stimulates a bite reflex. And so the jaws will come together and close, right? And so the jaw will kind of bite. Now if you push, push, push, you might see a biting up and down motion happening, right? So we're kind of stimulating this reef, but not kind of. We are stimulating this reflex by pushing on the gum region and telling the body, hey, like I'm giving you input. The body saying, hey, I'm going to, you know, open and close the jaw in response. So that's what that is. And it's actually something that we sometimes do like in feeding therapy to like reset because it, a lot of little ones, they enjoy that. It's a good feeling for them. So if they're upset or we're doing oral work, sometimes actually go in there and kind of, you know, stimulate that reflex because it helps to just kind of calm things down and bring things back to a sense of homeostasis if they, if there's any upset. But the Munch chew, let's go into the Munch Chew. So a Munch Chew pattern, this is basically an earlier chewing pattern and it combines that, that basic bite that we mentioned and also just takes it out of a reflex. Right now it's more volitional. And this we start to see that Munch Chew evolve around six months of age, which happens to be about the same time we recommend you introduce solid foods, right? So it's that, you know, vertical up and down movement of the jaw, okay. And it's literally just up and down. We're going up and down. We're not moving in a diagonal at all. We're not moving in a circle. We're just going up and down. So if we think about it, this is an early movement that allows us to break down foods. But also you're not going to give like a six month old who's new to foods a hard solid, like a pretzel or a carrot and expect that they're going to just like to, to, to, to, to, to. To form a bolus on the center of tongue and swallow it back. Right? Like, we don't expect that at this age. However, children sometimes get stuck here in this developmental stage and they don't move beyond a munch chew. And now they're two years old, now they're three years old. And it's really hard to chew when you can't grind foods down very well because all you're doing is munch chewing or even sometimes sick smashing. Sometimes they're smashing foods on their tongue, between their tongue and their palate. We see this oftentimes in children with oral dysfunction. We see this a lot of times in children who have limited food repertoires or diets. We see that they tend to prefer foods that are easier to smash, mash, you know, break down and swallow. And it makes sense, right? It makes sense as to why that may be the case because it, if all they can, if they can't move the food around and they can't grind the food properly, it takes a lot of energy. And also they're going to have trouble moving it around their mouth to mix it with saliva to break it down even further. So now we're talking about like munch, munch, munch. Food getting stuck kind of on the, the molar area, right, from that up and down movement. It's not being moved around. And so we also may have food falling into the cheeks and there may be some pocketing. We might have food all over the tongue and teeth, like kind of. We call it a scattered bolus, right. We start to see a lot of other things coincide with a munch chew that sticks around a bit longer than it should. And that munch chew really should evolve like from like the six to nine month point into starting to see some motion in the jaw. Now we don't expect a rotary chew at this point. At this point we so, and this, this is what I say is debatable. So when I say diagonal movements, there are certain professionals who feel that a diagonal shoe is part of the milestones. And I do see it in, in typically developing children that I have observed in this age, like between like, you know, 9 to 12 months of age or so. I've even seen it in some of like the kiddos who are a bit younger at times, you know, seven, eight, nine months. But basically a diagonal chewing pattern is where there is like this lateral and downward movement, like think a diagonal line. Okay. If you're Watching. You can watch me do this with my jaw. I'm going to pretend to put a piece of food in, right? Put food in. And we. We bring our jaw down. Like, let's say we go down into the left, right? And then we bring it back up to midline so the jaw meets the lower jaw meets the top jaw again. Right. But we don't move past midline to the other side. We don't. We don't complete a circle. We kind of just do like a half a circle, if you will, or a third of a circle, because we're going down a diagonal and coming back up to midline. And this is, again, it might be hard to understand conceptually, but the idea is that we are moving the lower jaw down and to the side, right? And then we're kind of releasing it back to the middle to the midline. And so this can help with placing food right on the molars. It can help you move food around, essentially, but it's not going to help you, like, grind food down. Okay. The grinding movement comes with a rotary chew. And that is definitely a more advanced skill. There's no movement across midline, right? I told you. We're kind of going down and laterally to the side and then coming back to midline. But we don't cross midline. We don't go across the middle. That would be the. That would be where we start to see a rotary chew. And rotary is like, circle, right? Circular chew. So we're seeing this with, like, vertical jaw movement. And we might even see presence of a vertical chew along, like a diagonal. 2. Sorry. Along with the vertical or munch. 2. Right. So this child may be doing a little bit of both. We might see, like, up and down, up and down, up and down. And then maybe they put in a new bite and they move their jaw over to move the food over. And then they. They bite and their jaw comes back to the middle. Right. So this is something that we see. It's. It's almost like a phase one of a. Of a diagonal or. Sorry, of a circular rotary chew. Right. Having that diagonal movement because. And I'm going to show in the video, in case you're watching, if we're talking about a adult, like, rotary chew, right. That has to start to emerge somewhere, which is what we typically will see. See, some of the. Some of it begins to emerge with this diagonal movement. When we put food in. I'm pretending again, and we start to chew now, we actually see that diagonal teeth come together. Jaw crosses, midline, goes to the other side. And actually it actually moves in more of a circular motion when we're chewing. Okay. So and I went back and forth there. If you're watching, that wasn't really a true circle, but I was showing you how I can go to both sides. Like, if you ever watch anybody chew gum and I'm doing this with my mouth open so people can see if you're watching. If you ever watch anybody chew gum, watch how they chew. Are they going like up and down, up and down, up and down? Or does it look like their jaws like moving kind of in a circle? Right. Start watching how people eat, watch adults, watch teens, watch young children, watch toddlers, you know, watch six month olds who are just learning to, you know, swipe food off a spoon for the first time. Right. It evolves. But this circular rotary chew is something that typically evolves. Like we might start to see a bit of it at nine months, but they have up until 36 months of age to get that rotary chew. And again, you can look at various different resources. The, we consulted many and putting together the milestone or feeding development milestone chart. Some places will tell you, oh, this is a pattern that's seen around, like seen in children by 15 months of age. And you know, we see that lateral and circular movement with it, right. While the tongue kind of freely moves side to side. And that's another thing we want to talk about across midline, right. It helps to clear teeth and form a bolus and all that fun stuff. But what I want to point out is that we really can't truly have an adult like circular rotary chew. Okay. That's super successful until that tongue works independently of the jaw. Like this all kind of starts to happen around the same time. And that jaw, like we call it jaw, lip and tongue dissociation, where they start to work separately from each other, that's expected by 18 months. Okay, so you might see it earlier, you might see it at 15 months. That's entirely possible. And it's possible that child will also have an adult like rotary chew and their tongue and their jaw and their lips and everything's working independently of each other by 15 months. That is entirely possible. But I also don't really expect that until about 18 months. And then I don't expect the adult like Rotary 2 to fully be in place until about 36 months. By 36 months, we should typically have, we shouldn't have mastered a lot of our typical oral motor feeding skills at that point, which is why 36 months is kind of that critical age. So hopefully this is helpful. Hopefully this helps to explain the difference between like the phasic bite, a munch chew pattern, a diagonal chewing pattern and an adult like rotary, circular rotary chew. Because this comes up so frequently and there seems to just be so much confusion around it. I know in our feed the Pete's course, which again, I'll plug it again, doors are open right now. Go to www.feedthepedes.com through September 23rd at midnight Eastern time and join us. It's a common point of confusion for a lot of like the SLPs and OTS in our course. And so I wanted to just make sure that we understand what these are, how they, the differences, the ages, they're expected. And also, you know, if you, if you download my feeding chart, that's part of my pediatric feeding screening packet, which is completely free, that is going to show you how certain skills match up. I match up the motor skills with the feeding skills and I break it down specifically by like what the jaw should be doing, what the lips should be doing and what the tongue should be doing. Right. We should be lateralizing between six to nine months of age. We should start to see that tongue lateralize, move side to side, work independently of the jaw. But we're still going to see it work together as one unit at times. And it's not until 18 months that we expect that tongue to the jaw and the lips to all do their job independently of each other. Meaning the jaw should move without the tongue having to move with it, the tongue should move without the jaw moving with it, and so on and so forth. We dive deep into this in the free training. So definitely go check that out if you're interested or join us in the course because we dive into this even deeper there@www.feedthepedes.com. i look forward to seeing all the SLPs and OTs interested in feeding inside our 12 week course together. It is a phenomenal program. You get lifetime access to the content afterwards, but it is, you get 4.05 or 40.5 hours Asha. It's 4.05 Asha and Aota, CEUs, SLPs and OTS. Or you can get 40, or was it 40.5 hours? Right, it's that the equivalent of 4.05 CEUs for Asha and Avata. All right, well go to www.feedthepede.com and join us. I cannot wait to see you in there if you have questions about this. I'm always happy to expand, but I thought a quick and dirty episode on the different types of chewing. You know, what we expect the jaw to be doing at what age and what that looks like would just be really helpful because we have to know typical development before we know atypical. So hope everyone has a great day. This is Hallie signing off. 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