Tongue Thrust: What Parents Need to Know

All babies are born with a tongue thrust reflex. Have you ever noticed your baby’s tongue sticking out while swallowing? 

Or maybe you’ve seen how, when a baby is fed pureed food, their tongue pushes forward while some of the food is pulled back into their mouth? The adult scoops the food off their lips and puts it back into their mouth. The cycle continues on and on until all of the food is gone. 

Both of these are examples of the tongue thrust reflex in action.

A tongue thrust or reverse swallow is completely normal in infancy. As babies grow older, they learn to swallow with their lips closed and move the food or liquid back towards the throat with a mature swallow. 

When tongue thrusting continues beyond early childhood, however, it can affect speech, tooth alignment, and oral development.

In this guide, we’ll explain what infantile tongue thrust is, when it’s normal, when it’s a concern and how pediatric dentists and orthodontists can help support healthy development.

The tongue thrust reflex (also called the extrusion reflex or reverse swallow) is something all babies are born with. It’s a protective mechanism that helps prevent choking during breastfeeding or bottle feeding and encourages proper latching. 

The good news? This reflex usually fades naturally.

As babies grow and develop, they gradually learn to use their oral muscles and engage in what’s known as a mature swallow. 

Here’s how a tongue thrust and mature swallow compare:

Infant or Reverse Swallow

• Tongue pushes forward
  
• Lips help stabilize the swallow
  
• Normal for babies and toddlers
  

Mature Swallow

• The tip of the tongue rests on the alveolar ridge (just behind the top front teeth)
  
• Lips stay relaxed
  
• The tongue moves the food, saliva or liquid backward with a rolling motion
  

The tongue thrust reflex typically begins to fade when a baby is 6 months old. In some infants, the reflex becomes a habit. But, even in these cases, most children develop a mature swallow by age 6 as they learn to move their tongue.

If the tongue continues to push forward beyond this age, especially if the tongue presses against teeth at rest or during swallowing, it may indicate a persistent tongue thrust. According to the American Speech-Language Hearing Association, persistent tongue thrusting is one of the most common orofacial myofunctional disorders (OMDs).

Parents often ask about a tongue thrust in autism. And, yes, it’s true that children with an autism spectrum disorder (ASD) may be more likely to develop a persistent tongue thrust. Why is that?

Well, in kids with autism, tongue thrusting can be due to:

• Differences in oral muscle coordination
  
• Sensory sensitivities
  
• Delayed oral motor development
  

Early evaluation is especially important, as tongue thrusting can contribute to feeding challenges, speech delays, and orthodontic issues if left untreated.

With a tongue thrust, the tongue continuously pushes against the upper front teeth. Because the tongue is a powerful muscle, this repeated pressure can significantly influence how teeth and jaws grow over time. 

That’s why, when the issue persists, it may contribute to:

• A gap between the top front teeth
• An open bite or overbite
• A narrow palate and subsequent crossbite
• Speech difficulties
  
• Jaw strain and temporomandibular joint (TMJ) dysfunction
  
• Orthodontic relapse later in life

As we said, all healthy babies are born with the extrusion reflex. But a persistent tongue thrust can be caused by:

• Mouth breathing due to conditions like allergies or enlarged tonsils or adenoids, all of which cause the tongue to sit between the teeth at rest.
• Prolonged pacifier use, sippy cup use or thumb sucking. The sucking motion can promote tongue thrusting.
• Skeletal issues that don’t leave enough space in the mouth for the tongue to sit in the correct position, such as an underdeveloped upper jaw.
• A tongue tie that inhibits tongue movement.
• Conditions that impact how little ones use their oral muscles, including cerebral palsy, ASD and Down syndrome.

A pediatric dentist can often identify tongue thrust during a routine exam by observing swallowing patterns, asking your child to make specific speech sounds and checking their tongue position at rest. They may also evaluate bite alignment and ask you about other oral habits. 

While getting a professional diagnosis is necessary because tongue thrust can present differently in different children, there are some common signs of a tongue thrust you’ll likely notice. Your child might:

• Stick their tongue out when swallowing or speaking.
• Mouth breathe.
• Position their tongue between the upper front teeth at rest.
• Frequently bite their tongue or cheek while eating.
• Spill food out of their mouth.
• Struggle to articulate certain speech sounds.
• Have a hard time closing their lips when swallowing.

You can also try this simple at-home test:

Have your child take a sip of water and swallow while you gently try to part their lips. The tongue shouldn’t move forward. Generally speaking, a child with a tongue thrust cannot swallow with their lips parted.

Treatment depends on your child’s age and the impact on their development. Options may include:

Observation

Some children naturally outgrow tongue thrust by age 6. If it’s not causing problems before then, we may simply keep an eye on it. 

Myofunctional or Speech Therapy

Myofunctional and speech therapy both use tongue thrust exercises to retrain the tongue posture and swallowing patterns. This approach is often needed when speech problems are present. 

Frenectomy

A laser frenectomy is a quick and easy procedure that releases a tongue tie, which can help in cases where tongue thrusting is caused by a tight, short or thick lingual frenulum. 

A Habit-Breaking Appliance

A habit-breaking appliance can prevent the tongue from pushing forward, helping to stop the behavior and correct tongue posture. 

Orthodontic Treatment

If a tongue thrust is impacting a child’s jaw development, we may recommend early interceptive orthodontic treatment using an appliance like a palatal expander while the child is still growing. This allows us to gently widen the upper jaw and create space for the tongue to function properly. 

For older kids and teens, braces or Invisalign® aligners may be recommended to correct tooth misalignment and bite issues caused by the tongue thrust.

The American Association of Orthodontists recommends that all children see an orthodontist by age 7.

Early evaluations help identify:

• Tongue thrust and reverse swallow patterns
  
• Bite problems like crossbites and open bites
  
• Airway and breathing concerns
  
• Jaw growth issues
  

Early evaluation doesn’t always mean early treatment, but it allows the orthodontist to time treatment to get the best results in the fastest, easiest and least invasive way possible. 

As part of the Innovative Dental Partners family, Innovative Pediatric Dentistry is under the same roof as Innovative Orthodontic Centers. This makes orthodontic checkups super convenient for our patients.

At Innovative Pediatric Dentistry, our Naperville pediatric dentists monitor oral development from infancy through age 13. If orthodontic intervention is needed for a tongue thrust or bite concern, we work closely with the team at Innovative Orthodontic Centers to ensure a seamless, coordinated approach. 

If the pediatric dentist notices signs of a persistent tongue thrust, our team will guide you through the next steps, whether that’s monitoring, therapy or an orthodontic referral.

Consider scheduling an evaluation if your child:

• Is older than 4 and still tongue thrusting;
  
• Consistently mouth breathes;
  
• Has speech delays or feeding challenges; and/or
  
• Shows spacing or bite issues.
  

Early awareness can prevent bigger concerns later.

The tongue thrust reflex is a normal part of infancy, but when it doesn’t fade, it can affect your child’s oral health, speech and smile development.

The good news? Tongue thrust is treatable, and negative effects can be avoided, especially when it’s identified early.

If you have concerns, schedule a visit at Innovative Pediatric Dentistry in Naperville today!