Tongue Thrust

What is tongue thrust (tongue thrusting)?

Tongue thrust is a habit that involves pushing your tongue forward against the back of your teeth. Your tongue may move forward when your mouth is at work — like when you’re talking or swallowing — or even when you’re resting. It’s most common in infants, but without treatment, tongue thrusting can continue into childhood and even adulthood.

If you’re noticing signs of tongue thrust in your child, it’s important to have a healthcare provider examine them. Over time, tongue thrust can lead to issues like speech disorders and dental problems like misaligned teeth (malocclusion or a “bad bite”). The good news is that there are treatments that can break your child’s tongue-thrusting habit.

What are the symptoms of tongue thrust?

Tongue thrust can look different in different children. Still, there are common signs to look out for. Your child may have tongue thrust if:

• Their tongue protrudes (sticks out) when they speak or swallow.
• They have trouble swallowing or food tends to fall out of their mouth easily.
• They accidentally bite their tongue or cheek a lot.
• They often breathe through their mouth instead of their nose (mouth breathing).
• They have trouble making certain sounds when they talk (especially “s,” “z,” “sh,” and “j” sounds).

Over time, the ongoing pressure of your child’s tongue against their teeth can lead to dental problems, including:

• Misaligned teeth: The most common alignment problem with a tongue thrust is an open bite. With an open bite, your top and bottom teeth don’t touch when your mouth is closed. Tongue thrust can also cause an overbite or underbite.
• Gaps between your teeth: The most common place for the gap is between the two upper front teeth.
• Jaw pain: Complaints that their jaw hurts may mean your child’s jaws or teeth are out of alignment. Over time, tongue thrusting can lead to temporomandibular joint (TMJ) disorders.

The signs of tongue thrust in adults are similar to those in children. By the time you’re an adult, you’re more likely to experience the effects of long-term tongue thrusting, like misaligned teeth and jaw pain.

What causes tongue thrust?

Tongue thrust can happen when infants don’t outgrow the “tongue thrust reflex,” also called the “extrusion reflex.” Healthy babies are born with this reflex, which causes them to push their tongues forward to prevent choking while nursing or bottle-feeding. The reflex starts to disappear at around 6 months, when babies are ready for solid foods.

Infants may continue to tongue thrust if the reflex becomes a habit — part of the way they learn to move their tongues. There are lots of potential causes for this, including:

• Using pacifiers and sippy cups past age 3. An object in your child’s mouth — like a pacifier, sippy cup or even a thumb — automatically positions their jaw and tongue down and forward. The sucking motion encourages tongue thrusting.
• Conditions that encourage mouth breathing. Allergies, a long-lasting stuffy nose, and enlarged tonsils or adenoids may make it hard for your child to breathe through their nose. To get enough air, they may lower and push their jaw (and tongue) forward as they breathe through their mouths.
• Anatomical issues. Children with a narrow upper jawbone or crowded teeth may have limited space in their mouths to position and move their tongues. This may encourage tongue thrusting. Tongue-tie may encourage infants to thrust their tongues to swallow.
• Nervous system conditions. Conditions that affect how your child uses their speaking and swallowing muscles can lead to tongue thrust. Examples include cerebral palsy, Down syndrome and autism spectrum disorder (ASD).

Anxiety and tongue thrust

In adults, tongue thrust is sometimes related to stress and anxiety. Anxiety doesn’t cause tongue thrust, but you’re more likely to jut your tongue forward when you’re doing other stress-related things, like:

• Teeth grinding (bruxism).
• Mouth breathing.
• Jaw clenching.

How is tongue thrust diagnosed?

Healthcare providers diagnose tongue thrust by checking to see if your child’s tongue protrudes or pushes forward when they’re speaking or swallowing. They may ask your child to say certain words. For example, if your child thrusts their tongue, they may pronounce “say” as “thay.”

Your child’s healthcare provider may check their teeth for signs of a bad bite. They may ask whether your child uses a sippy cup or sucks their thumb. If your child’s older, their provider may ask when you weaned them from these things.

How is tongue thrust treated?

Treatment options for your child depend on things like their age and whether they have dental issues. For example, some children naturally outgrow tongue thrusting by the time they’re 4 or 5. If tongue thrusting isn’t causing harm, your provider may decide to hold off on treatment to give them a chance to outgrow it.

Most children treated for tongue thrust are between ages 8 to 12. Treatment involves breaking the habit and correcting any alignment problems. Options include:

• Speech therapy. A speech-language pathologist (SLP) can teach your child how to strengthen and position their tongue correctly, so they’re no longer tongue thrusting. They may teach your child specific exercises involving their tongue, cheeks and lips that can correct tongue thrust. This type of training is called myofunctional therapy.
• A tongue crib. An orthodontist may fit this tongue-thrust appliance over your child’s back teeth. It creates a barrier that prevents them from thrusting their tongue forward against their teeth. Most children need to wear tongue cribs from 6 months to a year to retrain their tongue.
• Braces and tooth aligners. Your child’s orthodontist may need to fit them with braces or aligners to correct a bad bite.

Can tongue thrust be prevented?

You can’t prevent all causes of tongue thrust. But you can discourage unhealthy habits that can interfere with tooth and jaw alignment. You can:

• Wean your child from pacifiers and sippy cups around age 3. (While these devices can be helpful and comforting to babies, they can cause harm after a certain point).
• Discourage your child from sucking their thumb.

What can I expect if my child has tongue thrust?

For most causes of tongue thrust, the outlook is excellent. It may take a mix of speech therapy and orthodontic appliances, but in time, most children (and adults diagnosed later in life) can learn to stop tongue thrusting. These treatments can also correct problems related to long-term tongue thrust, like a bad bite or a speech disorder.

When should I see my child’s healthcare provider?

If your child is 4 years or older and is continuing to tongue thrust, schedule a visit with their pediatrician or dentist. By this age, most children have completely lost the tongue thrust reflex that kept them safe from choking as babies. Past this point, it could become a difficult habit to break that can create dental and speaking problems later.

What questions should I ask my child’s healthcare provider?

Questions to ask your provider include:

• What’s causing my child’s tongue thrust?
• Will they need treatment?
• How soon will they need treatment?
• What healthcare providers will we need to see?
• How long will it take to train them to use their tongue correctly?