Tongue thrust, also known as reverse swallow or immature swallow, describes a pattern where the tongue pushes forward against or between the teeth during swallowing, speaking, or at rest. While this reflex is normal in infancy, its persistence past the early childhood years is a concern because the constant, gentle pressure of the tongue can significantly affect the development of the jaw and the alignment of teeth. This habit can lead to dental issues, such as an open bite, and may also impair clear speech development. Recognizing and addressing this pattern early is important for promoting proper oral-motor function and preventing potential long-term complications.
Recognizing the Signs of Improper Swallowing
Identifying tongue thrust often involves observing specific behaviors and physical indicators related to the mouth and face. One of the most telling signs is the visible protrusion of the tongue between the upper and lower teeth, particularly when a child is swallowing or speaking. Since a person swallows between 1,200 and 2,000 times a day, this repeated forward pressure can exert a force of about four pounds per swallow against the teeth. This constant force often results in a dental condition called an anterior open bite, where the front upper and lower teeth do not meet when the jaw is closed.
Speech patterns can also reveal a tongue thrust, most commonly presenting as a lisp, especially on sibilant sounds like “s” and “z.” Instead of the tongue staying positioned behind the teeth to produce these sounds, it moves forward and often results in a “th” sound substitution. Other observable signs include chronic mouth breathing, which causes the mouth to rest open, and a visible strain or puckering of the chin muscle when the child attempts to swallow. Parents may also notice the child anchoring a straw with their tongue when drinking or frequently pushing food out of the mouth while eating.
Common Factors That Lead to Tongue Thrust
The persistence of the infantile swallow pattern is often linked to certain prolonged oral habits that interfere with the development of a mature swallowing pattern. These habits include extended use of pacifiers, bottles, or sippy cups, which naturally position the tongue low and forward in the mouth. Experts generally recommend transitioning children away from these items around 12 to 24 months of age to encourage proper oral muscle development. Similarly, persistent thumb or finger sucking past the age of three can also contribute to the habit by placing constant pressure on the teeth and influencing the resting position of the tongue.
Airway restrictions and chronic mouth breathing are major factors in the development of tongue thrust. When a child cannot comfortably breathe through the nose due to chronic allergies, persistent nasal congestion, or enlarged tonsils and adenoids, the jaw drops, forcing the tongue to rest low and forward. This open-mouth posture maintains an oral airway but prevents the tongue from resting correctly against the roof of the mouth. Structural issues like a tongue tie or a large tongue may also contribute by physically limiting the tongue’s ability to achieve the correct swallowing posture.
Practical Strategies for Early Intervention
Prevention focuses on proactively guiding the child toward a mature swallowing pattern by eliminating the environmental and habitual factors that contribute to the problem. Timely cessation of oral habits is the most impactful preventative step a parent can take. Pediatric dentists suggest weaning children from pacifiers and bottles by age two, as continued use reinforces the unnatural forward tongue position. Replacing a bottle or sippy cup with an open cup or a straw cup that requires more mature oral motor skills can help encourage the necessary tongue and lip movements for a mature swallow.
For children with a persistent thumb or finger sucking habit, parents should implement gentle, consistent strategies to help the child stop, often before age four. This may involve positive reinforcement, physical reminders worn on the hand, or addressing the underlying emotional need the habit fulfills. Encouraging a proper lip seal and nasal breathing is another key intervention, as the tongue naturally elevates to the roof of the mouth when the lips are closed and the child is breathing through the nose. Parents can periodically remind the child to “kiss their lips closed” when at rest or during quiet activities.
Airway Management
If chronic mouth breathing is observed, working with a pediatrician or allergist to identify and manage any underlying nasal congestion or airway obstruction is an important next step. Addressing issues like allergic rhinitis or enlarged adenoids can restore comfortable nasal airflow, which then facilitates the correct resting posture of the tongue.
Tongue Awareness Exercises
Gentle exercises to build tongue awareness can also be introduced at home. Encourage the child to place the tip of the tongue on the spot behind the upper front teeth and hold it there for short periods. These simple, consistent actions help to create new muscle memory for the tongue’s appropriate resting and swallowing positions.
Therapeutic and Orthodontic Management
When at-home preventative strategies are not successful or the tongue thrust is established, professional intervention is necessary to retrain the oral musculature and correct any resulting dental issues. Myofunctional Therapy (MFT) is a specialized program of exercises designed to correct the posture of the tongue, lips, and jaw at rest and during functional activities like swallowing. The goal of MFT is to teach the child to place the tongue’s tip against the alveolar ridge, the bump behind the upper front teeth, during a mature swallow. This therapy often requires a high degree of commitment from the child and family, with exercises needing to be practiced multiple times a day to establish new muscle memory.
Orthodontists may use specialized appliances, often in conjunction with or following MFT, to address the physical habit or resulting malocclusion. A habit breaker or a palatal crib is a fixed appliance that creates a physical barrier behind the front teeth to prevent the tongue from thrusting forward during swallowing. These appliances serve as a constant reminder and are typically worn for six months to a year to establish the correct pattern. Once the tongue thrust habit is addressed, traditional orthodontic treatments like braces may be required to correct the alignment of teeth pushed out of place by the chronic forward pressure.