What is Tongue Thrust and How Can it be Treated?
As speech pathologists, we always get this question: What is tongue thrust, and how can it be treated?
Tongue thrust is when the tongue protrudes past the teeth during speech, eating, or at rest. Although tongue thrust is a typical pattern/reflex in infancy, it can become a habit causing difficulty with eating, speech, and even breathing as children grow and develop. This habit is considered an orofacial myofunctional disorder (OMD), a ‘deficit that includes orofacial and oral muscles and can interfere with structural growth, function, or development’.
As a child develops speech sounds, you may hear the ‘th’ sound replace the ‘s’ sound (e.g., thit for ‘sit’, thad for ‘sad’). This speech pattern is commonly called a lisp and can persist if not remediated by a skilled Speech Therapist. In the case of a lisp, the child/adult is tongue thrusting during speech. The /s/ sound is produced correctly with your teeth slightly open and your tongue just behind the front teeth. As SLPs, we work to teach the child how to retract (pull back) their tongue and place their tongue behind their teeth as they produce the /s/. This process may help them improve the sound but not fix the underlying reason for tongue thrust. I will explain why in a minute.
As the child develops and visits dentists and orthodontists, tongue thrust is observed as a problem impacting proper teeth alignment. Orthodontists have told our SLPs they have seen examples of kids/adults who have finished their journey with braces and return just a few months later with their teeth in the original position due to tongue thrust. Movement of teeth occurs because the tongue, a powerful muscle, pushes on the front teeth during eating, speaking, sleep, and at rest.
When evaluating children (and adults!) with tongue thrust, we must analyze the root cause of this disordered movement. The root cause is a vital part of the overall treatment approach for the treatment to be successful. Let me explain why. When a baby is born (or even in utero), the tongue is an essential tool to shape the mouth and airway over time. Newborns breathe almost exclusively through their noses. Nose breathing allows the tongue to rest at the top of the mouth on the soft palate. This position allows the upper palate and jaw to grow as they should, promoting an expanded dental arch perfect for incoming teeth and breathing. If the tongue does not rest on the baby’s soft palate and creates a wider shape, the soft palate begins to arch and can arch into the nasal passages, even impacting breathing and sleep patterns. Dr. Zaghi, a world-renowned sleep surgeon, explains how tongue positioning can affect sleep: https://www.zaghimd.com/pediatric-sleep-breathing . When this child grows up, and their palate is arched, it is difficult for them to rest their tongue even if taught the proper placement. There are many reasons why they did not rest their tongue on the roof of their mouth at the start. We must get to the root of this to help them change their daily patterns forever.
If we see a child for tongue thrust, we will evaluate their mouth structures and movement patterns to see why the tongue is not spending enough time at the roof of their mouth. Is a structural abnormality present, such as an arched palate or tongue tie? Do the tongue, jaw, lips, and cheeks have the proper muscle tone and range of motion? If not, the child can create unusual motor patterns to swallow or speak that continue the tongue thrusting.
Once we get to the root of the tongue thrust, we work closely with your child’s dentist or orthodontist to be sure any additional needs are met. We will then create a customized exercise plan to encourage the tongue to stay where it belongs! For some examples of exercises we might recommend, check out my colleague Julia Conley’s post here.