The Swallowing Process

Understanding the mechanisms involved in eating can also be useful in understanding why a child is refusing to eat. The swallowing process is usually divided into three phases: oral, pharyngeal, and eso-phageal. In the newborn and young infant, all phases are driven reflexively by typical rooting and sucking behavior. As children age, the oral phase of chewing and managing food comes under more voluntary control, requiring cortical integration of sensory/motor input to coordinate the complex patterns of jaw, tongue, and oral movements. Factors such as smell, taste, and emotion become increasingly important. Once the process of chewing is completed, the tongue and soft palate propel the bolus toward the pharynx, initiating the pharyngeal phase of swallowing. As food progresses through the pharynx, a complex sequence of movements allows the safe passage of food around the airway into the esophagus. Closure of the mouth and nasal/laryngeal passages prevents aspiration while elevation and anterior displacement of the larynx opens the upper esophageal sphincter. This automatically generates a pressure gradient, which propels the bolus toward the esophageal opening. Once the food progresses to the esophageal phase, the subsequent movements are almost entirely automatic and no longer subject to cortical control. After passing the lower esophageal sphincter, food normally enters the stomach, beginning the gastrointestinal and absorptive phase of feeding. Food is emptied from the stomach based on the volume, nutrient composition, and caloric density of the meal.

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