What is a Tongue Thrust?
As feeding and swallowing therapists, we frequently see disordered swallowing patterns. One of these patterns is a tongue thrust. It can also be known as a reverse swallow, immature swallow, or deviant swallow pattern. But what is a tongue thrust?
A tongue thrust is an anterior swallow involving a forward motion of the tongue against the teeth to generate the pressure required to swallow food. This forward motion of the tongue is very useful when extracting liquid from a nipple in infancy. However, as we begin to eat solid foods, our swallow should change to a more mature swallow. This “normal” swallow involves generation of posterior pressure on the palate to facilitate the movement of the food into the pharynx or throat. In other words, we push our tongue to the roof of our mouth and this pressure moves the food to our throat. When we begin to eat solid food, we also develop lateral tongue movements to move the food to the sides of our mouth to chew on what will eventually become our molars.
What causes a Tongue Thrust?
There can be many causes of a tongue thrust. One often overlooked cause of a tongue thrust can be a tongue tie. A short or restricted lip or tongue frenulum also known as a lip or tongue tie can contribute to issues related to Tongue Thrust. If a lip or tongue tie is suspected a qualified Speech-Language Pathologist, Occupational Therapist, Lactation Consultant, and/or Pediatrician will most likely recommend an evaluation from an ENT for possible revision. Various exercises will also be used to facilitate more effective movements of the lips and tongue. These exercises can be performed with or without the recommendation for surgical revision.
If there is not a tongue or lip tie, there may also be deficits in the way the tongue moves. Weakness, decreased range of motion, poor coordination, and limited control of musculature can all contribute to difficulties moving food in one’s mouth. It is also important to consider where your tongue is placed at rest as this can have an impact on structure and function of various oral components.
What deficits can occur if my child has a Tongue Thrust?
Your tongue’s position at rest has a large impact on facial growth and development as well as speech and swallowing. For example, if your tongue is constantly pushing forward on your front teeth at rest, your teeth will begin to move forward and negatively affect your dental alignment. Furthermore, a significant amount of pressure is generated during each swallow while eating. If your tongue is constantly generating that pressure against your front teeth, your dental alignment will be further affected. Open mouth breathing can also be apparent if a tongue thrust is present.
Furthermore, a tongue thrust can have a significant impact on the way various speech sounds are produced. Speech sounds that are typically affected by a tongue tie include /s,z, t, d, n, l, r/, SH, CH, J, ZH. These sound errors are also sometimes described as a lisp.
We also see a significant amount of children who have difficulty transitioning to solid foods as an infant or have a limited food repertoire (only soft foods) as they get older. In addition, children with a tongue thrust may exhibit thumb sucking or prolonged pacifier, bottle, or sippy cup usage. A tongue thrust is certainly not the only cause of these feeding issues, but it could be a major cause.
What is the treatment for Tongue Thrust?
Treatment for tongue thrust should focus on changing the way the tongue moves. One way to change this movement is through Orofacial Myofunctional Therapy. This therapy involves neurological re-education of the orofacial muscles. This is accomplished through changing resting tongue posture, various oral motor exercises, and increasing awareness for proper swallow during real feeding tasks. Therapy may also involve eliminating pacifier/bottle usage and thumb sucking. It is also common to facilitate proper tongue movements during speech production.
The Speech-Language Pathologists at Building Bridges Therapy have completed coursework on Orofacial Myofunctional Therapy. Our team is happy to assist in identifying possible Tongue Thrust in your child. We will be able to assess possible deficits in speech and swallowing related to Orofacial Myofunctional Disorders. We look forward to serving you and your child!