Tongue Thrust is the frontal thrust or strong contact of the teeth during swallowing, in addition to inadequate lip closure, or incorrect lingual-mandibular resting posture.
The most common characteristics of a tongue thrust swallow pattern include one or more of the following:

• During the initiation of the swallow, the tongue moves forward between the anterior incisors, so that the tongue tip contacts the lower lip.
• During speech production, the tongue moves forward between the anterior incisors, with the mandible turned open (in phonetic contexts that do not require such placement of the articulators)
  • e.g., /sh/ sounds more like a voiceless /th/ sound, e.g., “thoe”/ ‘shoe’
• At rest, the tongue is carried forward in the oral cavity with the mandible slightly open and the tongue tip resting between the anterior incisors.

What causes Tongue Thrust?

A “tongue thrust” swallow is typical for infants and slowly matures as a child ages. Most children should develop a normal swallow pattern by 4 years, 6 months of age, however, it often takes longer (up to 6 or 7).

The most common causes include:

• Improper infant feeding (e.g., bottle feeding past 12 months, difficulty transitioning to table food, etc.)
• allergies (nasal obstruction causes mouth breathing and tongue to rest further forward in the mouth)
• enlarged tonsils and adenoids, or frequent sore throats, (causing difficulty swallowing)
• Mouth breathing
• thumb and finger sucking
• prolonged pacifier use
• genetic factors (inherited tendencies toward malocclusion)
• Tongue tie (short lingual frenulum)

The structure of the mealtime environment can have a major impact on a child’s eating behavior. Overall, strive for a positive environment that is predictable and supportive. To optimize the environment, consider implementing the following:

• Schedule regular meals for the family. Have everyone remain seated at the table for the duration of the meal.
• Avoid grazing. Offer only water between meals and snacks. This will support a regular hunger-satiation pattern and may help lead to increased daily food consumption.
• Minimize auditory and visual distractions at mealtime by turning the television off and keeping toys away from the table.
• Try limiting meals to 30 minutes and snacks to 10-15 minutes.
• Do not rush through meals. Your child may need extra time given their developing self-feeding skills.
• Mealtime is meant to be a social experience. Talk with your child about the food you are eating, ask him questions about his day, or discuss his favorite things.
• Be sure that your child’s seating allows free use of hands to encourage self-feeding.
• Model positive feeding behaviors for your child throughout the meal.

Common Referral Criteria for Occupational Therapy Includes:

Gross Motor: (Upper Body Strength, muscle tone, trunk stability)

 Slumps in chair
 Holds head up with hand
 Fidgety in chair
 Leans on things when standing
 Tires easily (fatigues before peers, difficulty finishing assignments)
 Muscles seem tight and rigid
 Muscles seem weak and floppy
 Low Endurance
 Tremors
 Difficulty with hopping, skipping, running, compared to same age peers
 Clumsy or seems to not know how to move body; bumps into things
 Tendency to confuse left and right body sides (after age 6)
 Falls frequently
 Reluctant to participate in sports or physical activity

Fine Motor: (grasp patterns, hand/wrist strength, in-hand manipulation)

 Awkward grasp on pencil/scissors
 Writing pressure too light/too heavy
 Drops things easily
 Flexes wrist when writing/cutting
 Experiences hand fatigue/pain
 Excessive hand perspiration
 Poor isolation on fingers on keyboard
 Writing not fluid
 Tries to avoid drawing, coloring, cutting, or writing
 Non-dominant hand fails to hold paper stable when writing/coloring
 Shows inconsistent hand dominance if older than age 6
 Difficulty manipulating fasteners
 Written assignments illegible (spacing, letter height)
 Immature/awkward scissors grasp
 Difficulty with keyboarding skills

Visual Perceptual/Motor/Handwriting/Oculomotor: (body perception, visual perception,
visual motor integration, eye-hand coordination, visual focus and tracking)

 Poor letter recognition
 Poor letter formation
 Poor letter/word spacing/alignment
 Inaccurate or slow copying/reading
 Difficulty completing reading/writing (loses place, omits words, add words)
 Poorly organized writing
 Cannot think of what to write about
 Poor drawing skills
 Unable to accurately draw a person
 Letter/word reversals (past 1st grade)
 Difficulty coloring within boundaries
 Difficulty staying on lines with cutting
 Confuses right/left (past kindergarten)
 Poor alignment of numbers in math
 Poor memory for written directions
 Poor spelling skills
 Moves head back and forth while reading
 Eye watering/rubbing/squinting
 Poor eye-hand coordination in gym
 Does not recognize or fix own errors well
 Difficulty with mazes and/or dot-to-dots
 Difficulty copying designs with manipulatives or on paper/graphs/dot maps
 Rubs eyes, squints, head close to paper
 Difficulty duplicating shapes, words, and numbers from the board, book, or model
 Looses place on page (reading or writing)

Sensory Processing: (touch, visual processing, auditory processing, movement, body
awareness)

 Avoids or has difficulty with eye contact
 Is easily distracted by visual stimulation
 Seems not to understand what was said
 Seems overly sensitive to sounds
 Appear reluctant to participate in sports
 Distracted by lots of noise and games
 Unable to follow 2-3 directions
 Prefers to touch rather than be touched
 Often seems overly active
 Avoids getting hands messy (art)
 Hits or pushes other children
 Seems more sensitive to pain than others
 Oblivious to bruises/heavy falls
 Complains that others hit/push him/her
 Mouths clothing/objects frequently
 Difficulty making friends
 Tends to prefer to play alone
 Has strong desire for routine/sameness
 Intense and easily frustrated
 Has strong outbursts of anger/frustration
 Lacks carefulness/Impulsive
 Bumps into things frequently
 Moves in/out of chair while working
 Falls out of chair
 Seems clumsy
 Seems to deliberately fall or tumble
 Distracted by background noises
 Fearful moving through space (swing)
 Avoids activities that challenge balance
 Avoids playing on playground equipment
 Extremely picky eater; often refuses foods kids typically eat at school/daycare

The Services of our Lexington location include:

•  Comprehensive Speech, Language and Feeding Evaluations
•  Individualized Therapy Sessions
•  Written Diagnostic Reports
•  Small Social-Pragmatic & Language Groups
•  Individualized Home-Programs following each session
•  School & Onsite Visits available for Evaluation & Therapy
•  Complimentary Conferences to discuss Progress & Evaluations
•  Parent/Teacher/Family-Based Education