I was sitting in my office finishing up paperwork when a little voice floated down the hall, talking about the “thooting thars.”
Adorable? Absolutely.
But as clinicians, our ears perk up when we hear those patterns.
But as clinicians, our ears perk up when we hear those patterns. That sweet lisp can sometimes be a clue, not just about speech, but about tongue position, oral posture, and an underlying tongue thrust pattern.
Understanding Tongue Thrust
A tongue thrust, also called a reverse or immature swallow, occurs when the tongue presses forward against or through the teeth. This happens during:
- Speech production (especially sounds like /s, z, d, t, n, l, sh/)
- Swallowing
- Rest
What Should Normal Tongue Position Look Like?
Ideally, the tongue should rest just behind the teeth with the tip anchored on the alveolar ridge (not pushing against the teeth or sliding between them).
Why Tongue Thrust Matters
A tongue thrust may seem harmless at first. “It’s not hurting anyone,” right?
But left untreated, you may notice:
- Open mouth breathing
- Dental malformations (over-bite, open bite, flaring teeth)
- Messy eating or difficulty managing foods
- A lisp that persists beyond early childhood (though a list is never “normal”)
- Tongue resting outside the mouth or between teeth
- Tension or overuse of facial and lip muscles during swallowing
Tongue Thrust vs. Habit: How to Tell the Difference
A habit is a learned pattern that responds to reminders or brief retraining.
A true tongue thrust is rooted in muscle patterning and neuromuscular coordination. It won’t disappear quickly and will reappear without consistent myofunctional work.
Quick Clues You’re Dealing With More Than a Habit
- The forward tongue pattern happens during both speech AND swallowing
- The lips and face visibly tighten to compensate
- The tongue rests low or forward even when not talking
- The pattern persists despite cueing or awareness
When in doubt, screen resting posture and swallow patterns. If the tongue tip isn’t resting on the alveolar ridge, or if there’s visible forward pressure on the teeth during swallow, document it as a tongue thrust pattern rather than a habit.
Documentation Language for Clinicians
Use objective, professional language in your notes:
- “Observed anterior tongue placement during swallow.”
- “Forward tongue movement noted on /s, z/ productions.”
- “Lips and mentalis activation observed during swallow.”
- “Oral resting posture: open lips, tongue low and forward.”
Avoid labeling it a “bad habit” or “lazy swallow.” Focus on what you observe during functional tasks.
What Treatment Actually Looks Like
In the past, you may have defaulted to giving an articulation assessment—but you’re missing the bigger picture if that’s all you do.
The Assessment Process
To understand why a pattern exists, a comprehensive orofacial myofunctional evaluation is needed.
Building a Treatment Plan
Treatment is determined by the outcome of the orofacial myofunctional evaluation. Once you’ve identified where the breakdown occurs (jaw instability, low tongue tone, poor lip seal, open mouth posture), begin treatment focusing on that root cause, not just the symptoms.
In Plain English
Find where the weakness lies within the orofacial complex and build a treatment plan from there. Focus on proper function of the orofacial muscles, and you’ll see the tongue thrust naturally resolve.
No archaic orthodontic cribs needed.
Myths vs. Facts
Myth: Tongue thrusts don’t need treating—kids outgrow them!
Fact: In the last week alone, I’ve heard three adults give speeches with visible tongue thrusts and lisps. You don’t always outgrow it. Period.
Myth: A habit-correcting device from an orthodontist is a good place to start.
Fact: Absolutely not. A tongue thrust results from disordered muscle movement patterns. Myofunctional therapy that retrains those muscle groups into correct movement patterns will naturally lead to correcting the tongue thrust.
Myth: As long as speech is intelligible, a tongue thrust doesn’t need to be addressed.
Fact: False! A tongue thrust impacts more than just articulation. Left untreated, it can lead to jaw tension, open bite, and incorrect or inefficient swallow patterns.
Want Support?
Realize that articulation therapy might not be the only thing you need in your toolbelt?
Or maybe you’re an RDH dreaming about getting away from the dental chair every day. You’ve taken your first myo course, but you want case-specific guidance?
Join The Myo Membership® / Pediatric Feeding Hub™ for office hours + HallieAI.
