Tongue thrusting is a natural reflex in infants where the tongue pushes forward against or between the lips while feeding or even at rest. This movement is part of a baby’s oral development and helps with breastfeeding and bottle feeding. For most babies, this reflex fades by 4 to 6 months of age.
Common Symptoms Associated with Tongue Thrusting in Infants
This chart visualizes common symptoms linked to tongue thrusting in infants. Open bite and difficulty swallowing are among the most frequently observed issues, often followed by speech delays and behaviors like thumb sucking and mouth breathing.
Why Do Babies Tongue Thrust?
Tongue thrusting in infants isn’t random — it has logical developmental roots. Think of it like a built-in training program that gets a baby ready for eating and speaking. Here’s what drives it:
- Feeding reflex: This is nature’s way of helping babies latch and suck effectively. The forward movement of the tongue is similar to how an adult might move their tongue to sip through a straw — it’s all about suction. This reflex is expected and even crucial during the first few months.
- Immature swallowing pattern: Babies under 6 months don’t yet have the coordination for a complex, mature swallow. Instead, they rely on a simple, instinctive motion. Imagine trying to learn a new dance move — at first it’s clunky and repetitive, but with time, the body refines the motion.
- Teething discomfort: Just like adults might press their tongue to a sore tooth, babies push their tongue forward to relieve gum pressure. It’s not a red flag on its own — it’s more like scratching an itch.
- Oral exploration: Babies discover the world through their mouths — similar to how a curious toddler uses their hands. Tongue thrusting can be a sign that a baby is exploring how their tongue moves, feels, and interacts with objects.
Each of these reasons is typical and, in isolation, rarely cause for concern. Tongue thrusting becomes problematic only when it lingers beyond developmental norms or interferes with feeding, breathing, or speech.
When Is Tongue Thrusting a Problem?
While tongue thrust is completely normal during early infancy, it becomes a concern if it persists beyond 6 to 9 months without signs of improvement. At this point, it may indicate an underlying issue with oral-motor development, airway obstruction, or even neuromuscular delay. Early identification can help prevent long-term complications.
Red Flags That Warrant a Doctor’s Visit:
Parents should monitor their baby closely for these warning signs:
- Tongue always peeking out between lips at rest: Occurs even when the baby is calm, asleep, or not eating.
- Feeding difficulties beyond 7 months: Baby consistently pushes solids out with their tongue, gags frequently, or resists spoon feeding.
- Speech-related concerns by 12 to 18 months: Delayed babbling, unusual sound patterns, or difficulty forming sounds that require tongue control (like /t/, /d/, or /n/).
- Dental signs: Gaps between teeth, early protrusion of upper front teeth, or visible pressure from the tongue on the teeth.
- Excessive drooling after 9 months: May indicate poor muscle tone or oral control.
- Mouth-breathing during the day or night: Can worsen tongue positioning over time and often ties to ENT issues.
If you observe a combination of these symptoms lasting more than 2–3 weeks, especially with no signs of developmental progress, it’s time to schedule an evaluation with a pediatrician, speech-language pathologist, or orofacial specialist.
Diagnosing Tongue Thrusting
Pediatricians or pediatric speech-language pathologists typically assess tongue thrusting. Evaluation includes a combination of hands-on observation and structured testing. Here’s what the process looks like for most families:
| Diagnostic Method | Description | Accuracy (1-10) | Average Cost (USD/EUR) |
|---|---|---|---|
| Clinical Evaluation | The doctor or therapist examines your baby’s mouth, tongue posture, and feeding behavior. They may gently move the tongue to see its range and strength and observe your baby during spoon or bottle feeding. This step is usually quick and non-invasive. | 7/10 | $100 / €95 |
| Speech Pathology Assessment | Conducted by a pediatric SLP, this assessment includes structured feeding tests, muscle tone checks, and early articulation exercises. Parents may be asked to provide video of mealtime at home. The therapist scores behaviors to identify patterns consistent with tongue thrust. | 9/10 | $200 / €190 |
| Video Fluoroscopy | A specialized X-ray video that shows real-time swallowing. The baby drinks a small amount of liquid with contrast, and the clinician views how the tongue and throat muscles function. It is painless but requires the baby to be cooperative during the scan. Usually used when other evaluations are inconclusive or more detailed info is needed. | 9.5/10 | $500 / €470 |
These methods are designed to be as gentle and child-friendly as possible. Most providers work hard to keep the child relaxed and even turn the process into a bit of a game. For parents, it helps to come prepared with a favorite snack, toy, or video on hand.
Treatment Options: Modern Approaches
While many infants outgrow tongue thrusting, persistent cases may require intervention. Here’s a breakdown of the most effective, modern treatments currently in use:
1. Orofacial Myofunctional Therapy (OMT)
OMT is a targeted exercise program designed to retrain the muscles of the face, mouth, and tongue.
- What it involves: Daily sessions (often 15–30 minutes), either at home or guided by a certified myofunctional therapist. Exercises include tongue-tip elevation, lip closure training, and nasal breathing practices.
- Who it’s for: Typically toddlers and children over 18 months.
- Effectiveness: Rated 8.5/10. Improvements are often seen within 3–6 months.
- Cost: Approximately $100–$150 (€95–€140) per session, with programs running 8–20 weeks.
2. Speech Therapy
Speech-language pathologists (SLPs) address the muscular coordination needed for proper speech and swallowing.
- What it involves: Customized sessions where therapists use tools like TalkTools or Z-Vibe to help the child learn to position the tongue properly during sound production and swallowing.
- Supplemental activities: Blowing bubbles, straw drinking, chewing exercises.
- Who it’s for: Babies showing early signs of speech delays and toddlers with persistent articulation issues.
- Effectiveness: 9/10 when combined with at-home reinforcement.
- Cost: $80–$200 (€75–€190) per session, depending on region and provider.
3. Orthodontic Intervention
For older children (typically 4+ years) with structural changes due to tongue thrust, orthodontic options may be needed.
- What it involves:
- Palatal expanders to widen the upper jaw and reduce tongue crowding.
- Myobrace systems, soft silicone appliances worn for 1–2 hours daily and overnight, that guide proper tongue posture and jaw development.
- Effectiveness: 8–9/10 depending on consistency of use.
- Cost: $1,000–$3,000 (€950–€2,800) depending on the device and orthodontist fees.
In all cases, combining treatment types and involving caregivers in home exercises significantly boosts success rates.
Types of Intervention Used for Persistent Tongue Thrusting
| Intervention | Usage (%) |
|---|---|
| Speech therapy | 50% |
| Myofunctional therapy | 30% |
| Orthodontic appliances | 25% |
| Surgical correction | 5% |
This chart compares different interventions for managing persistent tongue thrusting. Speech therapy is the most commonly used approach, followed by myofunctional therapy and orthodontic appliances. Surgical correction is reserved for severe or non-responsive cases.
Real U.S. Cases
- Boy, 10 months, Dallas, TX: His parents noticed that he was pushing food out with his tongue and seemed frustrated during feeding. A pediatric SLP diagnosed persistent tongue thrust and mild oral-motor delay. Weekly sessions using tools like the ARK Grabber and oral massage techniques helped build tongue control. Within three months, he transitioned successfully to textured foods and gained weight more steadily.
- Girl, 2 years, Atlanta, GA: Her dentist noted that her upper front teeth were starting to protrude. Her mother also observed excessive drooling and speech that was hard to understand. An orofacial myologist began working with her using Orofacial Myofunctional Therapy (OMT), including daily tongue positioning drills and straw training. After five months, her speech became clearer, and her dental alignment stabilized.
- Boy, 18 months, Phoenix, AZ: Diagnosed with enlarged tonsils and adenoids that contributed to chronic mouth-breathing and tongue thrust. An ENT performed an adenoidectomy, followed by speech therapy. Parents were trained to reinforce nasal breathing and use straw cups. The combined approach significantly reduced thrust behaviors within four months.
- Girl, 3 years, Minneapolis, MN: Her preschool teacher noticed she often spoke with her tongue visibly between her teeth. A full assessment confirmed tongue thrust related to a thumb-sucking habit that persisted until age two. A multidisciplinary plan included OMT, nighttime thumb guards, and consistent speech practice. By six months, her articulation improved, and she began to speak more confidently.
- Boy, 4 years, San Diego, CA: Already receiving speech therapy for articulation issues, this child showed no improvement until a therapist identified the underlying tongue thrust. He was referred to an orthodontist, who implemented a Myobrace system. Over the next eight months, with combined therapy and parent participation in at-home exercises, he showed marked improvement in both speech clarity and tongue positioning.
Prevention Tips for Parents
Many parents wonder what they can do to prevent tongue thrusting from becoming a long-term concern. Here are some practical, easy-to-apply strategies:
1. Start Spoon Feeding Around 6 Months
Once your baby reaches 6 months, gradually introduce pureed foods with a small, soft-tip spoon. Let the baby lead the process — gently offer the spoon and allow the baby to close their lips around it, instead of scraping food off with the upper gum. This supports proper tongue and lip coordination.
2. Avoid Prolonged Pacifier Use
Pacifiers are useful in the first few months but extended use (beyond 12 months) may encourage tongue thrusting and mouth breathing. Choose orthodontic pacifiers, and wean off gradually — for example, limit pacifier use to naps and bedtime, then phase out completely by 18 months.
3. Watch for Mouth-Breathing or Excess Drooling
Excessive drooling or mouth-breathing after 9 months can be early signs of oral-motor or ENT issues. If your baby seems to breathe mostly through the mouth or always has their mouth open, it’s worth checking with your pediatrician. Early evaluation helps catch tongue thrust before it causes delays.
4. Introduce Straw Drinking After Age 1
Straw use encourages proper tongue retraction and lip strength. Start with soft training straws and thick liquids like smoothies or yogurt drinks. Practice together and make it fun — babies love copying adults. This also lays the groundwork for better speech and feeding patterns.
5. Observe Tongue Position at Rest
If you notice your baby frequently has their tongue poking out when calm or asleep, gently guide it back in and mention it during checkups. It’s not always a concern, but regular observation helps track progress.
Remember, these aren’t rigid rules — they’re flexible guidelines to support healthy oral development. Parents who follow these steps can feel confident they’re doing the right thing.
Editorial Advice
Reyus Mammadli, healthcare advisor, recommends early monitoring of tongue posture, especially if feeding or speech delays are observed. “Parents often wait too long, thinking it’s just a phase. But if it continues beyond the typical timeframe, seek professional input.”
In general, most babies will outgrow tongue thrusting naturally. But for those who don’t, early detection and therapy can prevent future dental and speech complications.
Frequency of Tongue Thrust in Different Feeding Types
This chart presents the frequency of tongue thrust behavior among infants with different feeding practices. Bottle-fed babies show the highest prevalence, while breastfeeding appears to have the lowest association with tongue thrust.
References
- American Speech-Language-Hearing Association (ASHA). “Orofacial Myofunctional Disorders (OMD).” https://www.asha.org/
- Stanford Children’s Health. “Tongue Thrust in Children.” https://www.stanfordchildrens.org/
- Mayo Clinic. “Speech and language development: What’s normal?” https://www.mayoclinic.org/
- National Institute on Deafness and Other Communication Disorders (NIDCD). “Speech and Language Developmental Milestones.” https://www.nidcd.nih.gov/
- American Academy of Pediatrics (AAP). “Teething and Your Baby.” https://www.healthychildren.org/
- Journal of Orofacial Myology. “The effectiveness of orofacial myofunctional therapy in children with swallowing disorders.” https://www.journalot.com/
- ARK Therapeutic. “Z-Vibe and TalkTools: Tools for Oral-Motor Development.” https://www.arktherapeutic.com
- Myobrace. “Myobrace for Kids.” https://myobrace.com
- Cleveland Clinic. “Tongue Thrust: Causes and Treatments.” https://my.clevelandclinic.org
