In the following cross-section of the head and neck, the structures and muscles used during swallowing are identified.

     There are 4 main stages in the swallowing process:

1. Oral Preparatory Stage, in which the food is chewed (masticated), mixed with saliva, and formed into a cohesive ball (bolus)

2. Oral Stage, in which the food is moved back through the mouth with a front-to-back squeezing action, performed primarily by the tongue

3. Pharyngeal Stage, which begins with the pharyngeal swallowing response:
   • The food enters the upper throat area (above the voice box)
   • The soft palate elevates
   • The epiglottis closes off the trachea, as the tongue moves backwards and the pharyngeal wall moves forward

   These actions help force the food downward to the esophagus.

4. Esophageal Stage, in which the food bolus enters the esophagus (the tube that transports food directly to the stomach). The bolus is moved to the stomach by a squeezing action of the throat muscles.

     Following are general guidelines for safe swallowing:

1. Sit upright at a 90 degree angle for all oral intake
2. Take small bites - approximately ½ to ¾ teaspoon size
3. Take small sips - avoid gulping your beverages
4. Use a slow rate of intake
5. Make sure the mouth is completely empty before taking another bite or sip - avoid washing food down with liquid
6. Chew foods thoroughly before swallowing
7. Avoid talking with food in your mouth
8. Eat in a quiet place with few distractions