Since I started my private practice I have received a large amount of tongue thrust referrals. This is mostly due to the limited coverage of tongue thrust therapy through the school district. Where I come from – therapists are allowed to treat tongue thrust through the school district if the tongue thrust causes an articulation disorder. But they are not allowed to treat tongue thrust (or reverse swallow as it can be called) alone. This makes sense I guess – since an atypical swallow pattern doesn’t really affect a child’s ability to access an education like an articulation impairment does.
Anyway… all this exposure to tongue thrust has helped me perfect my techniques and my clients have had AMAZING success. Seriously. I love treating tongue thrust. It is simple, straight forward, and totally possible to fix.
But I would like to back up for a minute and talk about what a tongue thrust is exactly. I am going to explain it the way I like to explain it to the parents of my clients. I begin by explaining that a tongue thrust is actually an abnormal or immature swallow. I use the word immature because a tongue thrust is actually considered “normal” up until a child is about 8 years old (although I prefer for children to have adapted to a more mature swallow much sooner). A tongue thrust is the type of swallow that a baby uses. In this type of swallow the back and middle parts of the tongue are fairly lazy. They just kind of “come along for the ride” while the tongue tip does most of the work. This type of swallow is critical for a baby because it allows the baby to use their tongue tip to expel liquid from a nipple (breast or bottle). To understand this type of swallow better I actually filled one of my baby’s bottles and drank from it (are you grossed out yet???). But seriously – I did. I wanted to understand the process better so I could explain it to my clients and their families better. I suggest you try it as well if you are trying to get a better understanding of tongue thrust. You will notice that the tip of your tongue does most of the work. The tip of your tongue just has to put pressure on the nipple to allow the liquid to flow from it. You will also notice that your tongue is almost required to push up and forward to expel the liquid.
Another way to understand a thrusted swallow better is to watch a baby try to eat baby food. The reason babies are so messy is because they swallow with a tongue thrusted swallow. Their tongue is so used to pushing up and forward to swallow – that it continues to do so even when it is introduced to more solid food. However, this type of swallow is much less effective for swallowing solid food – so typically – over a process of years- a more mature and effective swallow pattern will begin to develop.
Instead of a forward/upward scraping motion that occurs in a thrusted swallow, a more mature swallow begins with the tip of your tongue pressing against the bumpy spot behind your top front teeth (your alveolar ridge). The middle, sides, and back of your tongue then should suck up against the roof of your mouth (while your tongue tip remains on the bumpy spot) to push the food back toward your throat.
You can see now why a thrusted swallow is often referred to as a reverse swallow. In a thrusted swallow the tongue is pushed up and forward (in a scraping motion), in a mature swallow the tongue is pushed up and back (never pushing against or past your front teeth).
You can see how in a thrusted swallow the back and middle of the tongue are pretty non-active, but in a mature swallow they are working a lot harder. As a child develops a more mature swallow – the back and sides of their tongue begin growing stronger and gain more control of movement. This has huge implications for articulation. If a child fails to transition to a more mature swallow, the back and sides of their tongue fail to mature as well. This is where we begin to see difficulty producing sounds that use the back and sides of the tongue (/r/, /sh/, /ch/, /j/). But we also see difficulty with fricative sounds (sounds that require pushing airflow out) that involve the tongue (/s/, /z/, /th/). This is because the back/sides of the tongue do not have the strength/stamina to hold the tongue in the correct position against the pressure the airflow creates. I kind of explain it in terms of posture. Your tongue has a correct posture inside your mouth for these sounds with airflow (s/z/th). But as soon as you begin blowing your air out, the tongue gets pushed forward as well. It is not strong enough to resist the airflow and maintain its correct position.
Are you still with me??? I realize this is a lot of information. I hope it is making sense.
I have had many articulation clients come to me because they needed help producing one/some/all of these sounds (s, z, th, r, sh, ch, j, etc). I determined they had a thrusted swallow, and I treated their thrusted swallow without ever actually treating the specific sound errors they had. Many times the sound errors corrected themselves once the swallow was corrected. This isn’t always the case – sometimes I have to work on the specific sound errors once the swallow is corrected – but the therapy goes much faster once the thrusted swallow has been corrected.
This is why a greater understanding of tongue thrust is so important. If we don’t know how to diagnose it or treat it – our client’s articulation errors can often be difficult if not impossible to fix – because their abnormal swallow is undoing everything you are doing during therapy.
It is also important to have a greater understanding of tongue thrust because it is so prevalent. If you haven’t treated tongue thrust as a therapist – I assure you it is just because you haven’t realized that was the problem – not because the problem was never there. Tongue thrust is very common and I assume – very underdiagnosed. The reason it is so common in our day is, I believe, because of the introduction of so many “false nipples” in our society. “Back in the day” babies would nurse from their mother until a certain point when they were weaned, this allowed the more mature swallow to begin development. “Now-a-days” babies have bottles, pacifiers, and sippy cups. All of these things contribute to babies/toddlers using a thrusted swallow for longer periods of time than they should. And it almost seems like if a child misses the opportunity to develop a more mature swallow, they lose that ability and never end up developing one. I have treated many adults as well that have swallowed using a thrusted swallow their entire life. Sometimes the thrust affected their speech, the way others perceived them, their success in social situations and careers, etc. A thrusted swallow can have negative life long affects.
So, we as therapists need to do better to understand and treat tongue thrust. And this is just the first step I am taking. Now that we have discussed what a tongue thrust is, I am planning on giving tips and pointers as to how to treat it in later blog posts. For now you can check out my tongue thrust brochure that explains better the signs, symptoms, and causes of tongue thrust. And like always – let me know if you have any questions. Thanks.