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.
Thank you for blogging on this topic. Can’t wait to hear your tips! Love your site!
This description has been very helpful and provides one reason that those /r/ kids can’t seem to get the backs of their tongues up nor be able to separate their jaw movements from their tongue elevation. When I was in college, the colleges would not give any info on tongue thrusting, telling us we could take a course (outside of school) from a private individual ! It was felt that this was something to be done through the dentist rather than SLPs.
That is very interesting. I also feel like
I had very little training about tongue thrust in college. I was just lucky enough to be assigned to treat a tongue thrust client as a graduate student clinician – where I was given some guidance by a supervisor. After graduating I began researching tongue thrust on my own. I also have amazing orthodontists in my area that refer clients to me like crazy – so I had to really figure out what I was doing. It has taken me YEARS to perfect my understanding and treatment of tongue thrust to the point where it is extremely effective. It’s sad that people think it should be left up to orthodontists. From the feedback I have been given from them – they are even more clueless than most SLPs.
I also can’t wait to hear your tips! Post them as soon as possible!
I’m a cfy and have my first tongue thrust client! It’s been a challenge for me so far, so I’m sure your tips will be very helpful!
In your opinion, how far can tongue thrust and articulation therapy be effective with the open bite often found in thumb suckers, late wean-“ers”?
Tongue thrust therapy is VERY effective for these types of children. In fact – I would say it is what the treatment is made for. Some kids take a little longer depending on how severe the thrust is, but all kids (at least that I have seen so far) have made great improvements.
I am seeing more and more of this in the schools. I’m seeing the artic problems associated with the tongue thrust. I look forward to your tips!
I loved the detail of your post . I have several children in Speech for articulation/tongue thrust. Your description was very helpful. Can wait for more information.
Very effective tips and information giving by you I really appreciate your work. We are also in same field and welcome you to visit our website
Great info! So thankful I found your site.
Our eligibility form in the school system has tongue thrust as an exclusionary factor. (It actually says “Is the child free from selective mutism, tongue thrust, or dialectal differences in language?” on the eligibility form as an exclusionary factor. If “no” is selected, it says the child is not eligible until the exclusionary factors are resolved.) What do you think about this?
What great questions!!! And I do have many opinions regarding this topic – especially tongue thrust being an “exclusionary factor”. When I worked in the school district we had a similar eligibility form in which we had to consider exclusionary factors as well. And in the years that I worked there the form changed a few times (as well as the interpretation of the form).
I recently attended a speech therapy conference where the speaker discussed dialectal differences and how to include that information in the evaluation/eligibility/decision making process. In the end of her talk – the conclusion was that some children can have a speech/language disability while having a dialectal difference, or a child could just have a dialectal difference. The main point is to determine if it is just a dialectal difference – or a speech/language disability – or both. A child might speak more than one language – but still have a speech/language disability.
The reason I bring this up is I feel the same way about tongue thrust. There are a lot of children that have a tongue thrust that do not have any articulation difficulties, but there are many children that have a tongue thrust that CAUSED their articulation difficulties.
WHY WOULD WE EXCLUDE THAT CHILD FROM TREATMENT BECAUSE WE WERE ABLE TO IDENTIFY THE CAUSE OF THE PROBLEM???? Especially when we are the only professionals trained to treat the problem?
It makes no sense – right?
I think the form should read like this:
“Is the child free from selective mutism, tongue thrust, or dialectal differences in language?” If “no” is selected, the child is not eligible until the exclusionary factors are CONSIDERED (instead of resolved).
If the child has a tongue thrust – and is not eligible to receive help from an SLP – how will that specific exclusionary factor be “resolved”?
I think the district I worked for had it spot on the last few years I worked there. Like I said in the beginning of the post. We were able to treat tongue thrust as long as there was an articulation disorder present as well. But we were not able to treat tongue thrust if there was no articulation disorder. This makes so much sense. The first circumstance – tongue thrust with articulation disorder – DOES actually have the potential to negatively impact the child’s educational performance. The second circumstance – a tongue thrust with no articulation problems – DOES NOT actually have the potential to negatively impact a child’s educational performance. How does a slightly different swallow effect education? It doesn’t! But it does affect the education if the tongue thrust is causing a speech impairment.
If a child exhibits a tongue thrust with no articulation disorder – the only negative impact that tongue thrust will have is the ability to misalign the bite/teeth/etc. This negative impact does not at all effect a child’s education and does not fall under the umbrella of responsibility of a school district.
If a child has a tongue thrust that causes an articulation disorder – the negative impact has the possibility of affecting the child’s education. The possibility of negative impact needs to be CONSIDERED by the IEP team and a decision needs to be made by the team determining whether or not the child should receive services. How much does the articulation disorder affect the child’s education, etc???
But just because a child does have a tongue thrust – that should not be an automatic exclusion from services.
Just my two (or two hundred) cents. Sorry for such a long answer 🙂
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Also, any chance you will be presenting at ASHA schools conference in July???
No. Bummer. I just had my third baby – so any extra travel for the next few months is not in the works for me. Sorry.
Is there quick way to diagnose a tongue thrust vs. just a frontal lisp? Or do they usually go hand-in-hand? I recently screened a child with frontal lisp, with slight jaw sliding to right. When I asked him to swallow while biting & smiling, I saw his tongue move forward slightly. When I asked him to make the /s/ sound while keeping his teeth together, I could not get a clear, crisp /s/. Does this sound like tongue thrust? & is there another way I can confirm whether or not it is? My district does not typically qualify for tongue thrust even with artic errors, but I may try to treat this “at risk” and want to be sure what I’m looking at. Thanks so much for any input – sorry so lengthy!
You can check out my Tongue Thrust Checklist. This is an easy way of looking at all of the aspects of the child’s swallow/speech and making a diagnosis. It sounds like tongue thrust to me – but is difficult to tell without seeing the child myself. Good luck.
its a great topic, so i wonder if theres a specific word that the patient have to say to help us to diagnose that show that they have tongue thrust?
Hi! I just came across your blog while researching tongue thrusts. My daughter is 2 months old and constantly has her tongue out of her mouth (is this considered a tongue thrust/I’m just assuming it is). Her tongue is constantly pushing forward even when she’s drinking a bottle. She can’t seem to keep Her tongue in her mouth. I’m concerned and I’m not sure if it’s warranted or not. Everyone around me says she’s too young for it to be a problem but I’m just wondering if there’s anything I can do at home to help with this issue.
Great understanding. She does have a tongue thrust. But, ALL babies have a tongue thrust. However, over time – that thrust should transition to a more mature swallow. I would not be concerned at all at this age – but if it never goes away you can check out my program at http://www.BustTheThrust.com.
I came across your post & just had a few questions. My 2.5 year old son has a tongue thrust, attached lingual and labial frenums, and when he sleeps he is a mouth breather for the most part. He was seen by a SLP for about 5 months just to get a “boost” with speech. I took him to an oramyofunctional office & she basically said it is a bit early to do any sort of physical therapy regarding his thrust & low muscle tone. She did suggest some little things, like drinking through a straw or practice certain mouth movements that he could repeat, etc. Just curious what your opinion is on if I can wait a little longer & see how things go as his speech progresses. He talks but he also, at times, trys and tell me something that is unintelligible (I usually understand a word or two). I’m also wondering if having a frenectomy done is worth it at this time (he had his lingual frenulum snipped when he was about 8 weeks old but it is still tight). Also, he has never seen an ENT so I’m wondering if that is something that would be helpful as well? Just want to stay on top of it. Any insight would be great! Thanks in advance!
Would you begin treatment when the child has lost two bottom front teeth and is about to loose two top fronts? Or would you wait until the adult teeth have grown in a bit? I know we are looking mostly to correct tongue placement and function but do you feel it might be less successful without the tactile structures as a reference?
I think you would be fine either way – but I would maybe wait until the teeth grew in a bit just to give the child the best chance at success.
I work in a school and have a kindergarten student who presents with frequent open mouth posture and tongue protrusion at rest. No reported feeding problems but erroneously dentalizes some alveolar sounds and has a frontal lisp for s. Her speech quality is not adversely affected by these habits, either in quality or intelligibility. However, she would be a much more appealing conversational partner if one did not get to see her tongue in action so often. Also her dentition seems odd, as she cannot occlude the top front teeth against the bottom. Rather there is a bow-shaped gap between the two. When directed to produce “s” without protruding her tongue the effect is one of distortion.
This is not my area of expertise and whatever advice or information you could provide would be greatly appreciated!
It sounds exactly like tongue thrust. Especially the bow shaped gap. This is a tricky situation being that you work in a school. Ethically you are only allowed to offer services if the child’s tongue thrust adversely affects their educational performance (i.e. articulation problem). If her articulation is not affected that can be a tricky call. Her tongue movement and thrust definitely affect her dentition and she will need tongue thrust therapy in order to close that gap (even with braces – as the pressure of her swallow will just push the gap back open). So – does she need therapy – the answer is yes. But does she need therapy in an educational setting – you would have to check with your districts policies to make a final determination. You can also check out http://www.bustthethrust.com for more info on tongue thrust.
Hi there. Just want to say that I love your website! I have a question about the Bust the Thrust program. Are there sample goals included in the program? I’m finding it very hard to find any samples out there with respect to models of well written measurable goals, and since I myself have never had to write a goal for a tongue thrust, I’m really not sure how to do that and what parameters to include, or how really to make it measurable. Not sure if you have any advice on this, or if it’s specifically included in the Bust the Thrust program? It would be extremely helpful. Thanks so much!!
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