Tongue Thrusting in Children

Tongue thrusting, also called reverse or immature swallowing, is the habitual activity of pushing the tongue forward against the lips to seal the mouth for swallowing. Tongue thrusting repeatedly places pressure on the upper front teeth which can cause them to be pushed out of alignment over time. Tongue thrusting is normal in young infants, however, as a child becomes ready for solid food (usually around six months of age), the tongue and orofacial muscles begin to strengthen and the teething process starts, at which time a child typically develops a mature swallow (the tongue is pushed back and up). Learn more in Dental Topics.

Possible causes of tongue thrusting include:

• Thumb sucking
• Ankyloglossia (tongue tie)
• Macroglossia (enlarged tongue)
• Enlarged tonsils
• Allergies/nasal congestion
• Upper respiratory infection
• Mouth breathing
• Some artificial nipples used in feeding
• Physiological abnormalities
• Heredity

While most children naturally outgrow tongue thrusting before age four, it is not uncommon or a cause for concern if a child exhibits tongue thrusting up to four years of age. If a child continues to tongue thrust after age four, the habit becomes strengthened and often requires a retraining program or orthodontic assistance to correct. If left untreated, tongue thrusting can have adverse effects on the teeth and mouth.

How Can Tongue Thrusting Affect the Teeth?

Tongue thrusting causes the tongue to be in an incorrect position while swallowing. Each time a person swallows (usually 1,000-2,000 times per day), approximately four pounds of pressure is exerted. When the tongue is incorrectly placed while tongue thrusting, this pressure pushes against the teeth, which can force them out of alignment. After the age of four, this subconscious habit can be difficult to reverse.

Possible effects of tongue thrusting include:

• Teeth misalignment (open bite)
• Erratic mandibular (jaw) movement
• Irregular tongue movements
• Reversal of ongoing or prior orthodontic treatment

What is the Treatment for Tongue Thrusting?

The treatment technique that has been proven most successful in correcting tongue thrusting is oral habit training. This method involves an exercise plan to reeducate the oral muscles that are used during swallowing. A trained speech therapist can help implement this change in the swallowing pattern to allow the tongue to become accustomed to staying in its proper position. If thumb sucking and/or tongue tie is involved, these should be treated prior to beginning the tongue thrusting therapy.

Orthodontic Treatment for Tongue Thrusting

In some cases, an orthodontic appliance similar to a retainer may be recommended to help correct tongue thrusting. A custom orthodontic device (called a tongue crib or gate) can be designed specifically to suit your child’s needs. The device may only need to be worn at night, but more frequently, the tongue crib is attached to the molars or an expander and remains in place until treatment is completed and the orthodontist removes it.

How Does a Tongue Crib Work?

The tongue crib is placed behind the top front teeth to prevent the tongue from pushing against the teeth. The crib also keeps the tongue from protruding during swallowing. In this way, the tongue becomes retrained to stay in the correct position for swallowing. The length of time the tongue crib is worn varies from case to case and may be a few months or may last the duration of orthodontic treatment.

As with any orthodontic appliance, good oral hygiene and avoidance of hard, sticky foods are recommended to keep the device in proper working order. Tongue thrusting correction techniques (tongue therapy and/or the use of an orthodontic device) are most successful when both the patient and parents are committed to the treatment.

If your child has not outgrown tongue thrusting or you are concerned that tongue thrusting has caused misalignment of your child’s teeth, please contact the pediatric dental specialists at Kids Dental for an evaluation.