My Swallowing Is My Business (revised from 11/6/14) with the good taste of M. Elwer

This post offers a glimpse into what I call “organic SLP” — speech-language pathology that grows from real human experience and education. The goal? Empowering patients to understand their own bodies and take action to prevent disability whenever possible. One of the most effective ways to do that is by teaching the basics of normal function. This handout, originally created for an actual patient, is just one example. As always, your feedback is welcome!

⸻ Most of us don’t think about swallowing — and why would we? I certainly didn’t, at least not until it became part of my clinical focus. The truth is, I started swallowing long before I ever had a conscious thought. Scientists have found that human fetuses begin swallowing around 15–16 weeks of gestation. I developed my first taste preferences in the womb. After birth, I was fed by others and eventually learned to feed myself, developing the skills to get food into my mouth and down the hatch.

As a child, swallowing was something I could do in just about any position. I ate sitting upright, of course — but also lying flat on the couch, hanging upside down, and even mid-spin on a carnival ride. I did it because I could. I didn’t think much about posture or process. As I got older, however, I began to notice that swallowing worked more easily — more efficiently — when I was upright. Gravity helped, coordination improved, and things just felt smoother. Swallowing is both voluntary and involuntary. Some muscles I control intentionally — like those involved in chewing and moving food with my tongue. Others work automatically, governed by brain regions that don’t require conscious effort. These two systems — voluntary and automatic — work in seamless cooperation, allowing me to swallow thousands of times a day without giving it a second thought. Over the course of my life, swallowing has become a set of deeply ingrained habits — a finely tuned sequence of motor memory. Here’s what it looks like for me:

I pick up food with my fingers or a utensil. For liquids, I use a spoon, cup, or straw to bring the fluid to my lips. I hold the food or liquid on my tongue, shape it into something manageable, and either chew or compress it until it forms a cohesive, slippery mass (known as a bolus). I then use my tongue to squeeze the bolus to the back of my mouth. That’s the point where control starts to shift — when my swallow is “triggered” and the automatic part takes over. The bolus is propelled into my throat. My larynx (voice box) lifts, the airway is protected, and a valve to the esophagus opens. Once the material enters the esophagus, it’s carried to the stomach by rhythmic waves of muscle contractions. That, in short, is my swallow. And yes — my swallowing is my business. It matters to me because eating is about more than nutrition. I eat to live. I eat for comfort. I eat to connect with others. That’s why I teach patients to care about their swallowing, too. Because when we understand what our bodies are doing — and how to support those processes — we can protect our quality of life. My body. My business. My swallow.