“Tongue Thrust” Therapy: Speech Therapy is Not Just for Speaking
By Daniel A Miller, MS, MA, CCC-SLP
The term “tongue thrust” typically refers to a pattern of swallowing in which the individual pushes forward against or between the front teeth (usually, the incisors). This behavior is a part of typical development, but is expected to decrease in frequency as a child matures. If tongue thrust persists beyond age 4-6, it is increasingly unlikely that the child will outgrow this pattern of swallowing on his or her own. Additionally, in children with tongue thrust, when the tongue is at rest it typically sits in a more forward position, against the front teeth. Persistent tongue thrust can lead to problems with dental alignment, including teeth pushed outward or wide spaces between teeth.
Tongue thrust can be a “swallowing only” behavior, but often it also comes with articulation differences such as producing /s/ and /z/ with the tongue protruding between the upper and lower teeth. This can result in a /th/ or /th/-like sound (“sit” would sound like “thit”) and is one of several speech patterns that people refer to as a “lisp.” Speech-language pathologists generally refer to this articulation pattern as “frontal distortion” or “dentalization.” This also occurs as a part of typical development in children, but is expected to fade from a child’s speech by age 5-6. These articulation differences can occur without a tongue thrust swallow, just as a tongue thrust swallow can occur without articulation differences.
Common signs of tongue thrust include the following:
- Wide gaps between teeth
- Front teeth are “flared out”
- Front teeth do not close together when the child bites down
- Lips are open at rest, tongue is forward
- Chronic mouth breathing
- Speech sound substitutions (/s, z, t, d, n, l/ produced with tongue protrusion)
Orthodontic work is generally indicated to correct tooth placement, and families should start a conversation with their dentist or orthodontist about this. However, the tongue thrust swallow pattern also needs to be addressed, and this is where speech-language pathologists can help.
Tongue thrust can be addressed through therapy, with the goal of therapy being to teach a healthy swallow pattern and prevent the tongue from pressing against the teeth. If a child has orthodontic work done but the underlying cause of the dental alignment problems (tongue thrust) is not addressed, the child may push their teeth back to their pre-orthodontic positions after orthodontic work is completed.
Therapy for tongue thrust is typically short term, but work intensive. At our clinic we recommend one appointment per week for twelve weeks (this will vary based on the child’s response to therapy). Sessions are spent teaching appropriate placement for the tongue and performing lingual exercises to practice the swallowing motion (first without food or water, then with water only, then soft foods, and on to hard/crunchable foods). Daily home practice is assigned and we advise families to complete the exercise regimen with their child three times per day between appointments. Therapy is generally not recommended until children are older, typically age 8 or later. If there are also articulation differences such as tongue protrusion during productions of /s/, your speech-language pathologist will also be able to help with this, during or after therapy for the swallow pattern.
Speech therapy does not correct dental alignment by itself, and orthodontic work is usually required after the completion of the therapy program, or sometimes simultaneously with it. Not all speech therapists are trained in therapy for tongue thrust, so it is important that you request a therapist who has had experience with this sort of therapy in the past. If you have questions about tongue thrust, it is recommended that you start a conversation with your dentist or orthodontist, and be sure to ask whether referral to a speech-language pathologist would be appropriate.
