Tongue Thrust and Starting Solids

You may have heard that one of the signs of readiness for solid food is the disappearance of the natural language thrust.  This claim, however, is not supported by research and it is our professional opinion that the thrust can be helpful when starting solids. Let'south dig in.

What is tongue thrust?

The natural language thrust, or extrusion reflex, is a reflex present at nativity that persists until iv to 7 months of age in typically developing babies. ¹ In immature infants, the tongue thrust is stimulated by touching the tip of the tongue, causing the tongue to "thrust" or stick out of the rima oris. A strong natural language thrust reflex causes the tongue to extend by the gums and lips; a natural language tie may cause some restriction.

Another reflex nowadays at birth is the root reflex. This reflex helps baby latch at the breast or on a bottle nipple and causes baby's tongue to extend or stick out of the oral fissure before information technology pulls the breast or canteen into the mouth. Like the natural language thrust reflex, the root reflex is present until iv to 6 months of historic period. ²

Because of the natural language thrust and root reflexes, the forward thrusting of the tongue is a well-established and strong move pattern past 6 months of age, even if the reflexes accept integrated or disappeared.

Charlie, one month old.

Charlie, i month onetime.

What does the tongue thrust reflex do?

Interestingly, the evidence in this area is lacking; there is almost no inquiry examining the function of the tongue thrust. Most documentation is clinical opinion based on observations of dentists, lactation consultants, feeding therapists, and pediatricians.

Many experts believe the main functions of the tongue thrust reflex include:

• Swiftly pushing items out of the mouth
• Keeping the airway clear
• Protecting against choking

Newborns and immature infants take immature oral motor skills, poor head and cervix control, and often prevarication on their backs or in a reclined position with gravity moving things towards their throat. Additionally, babies lack the fine motor skills needed to pull items out of the mouth. So, without the tongue thrust, if any item should accidentally finish up in the mouth, an infant would be at a high risk of choking. The tongue thrust reflex appears to protect infants with reflexive skills enabling them to button things back out of the mouth when necessary. As the reflex fades and babies learn more coordinated tongue and finger movements, they tin spit things out of their oral fissure as needed.

Some professionals feel the tongue thrust reflex is present to assist babies stick out their tongue to latch at the breast, only nosotros disagree with this theory. To latch, the infant's caput needs to turn towards the breast or bottle, the mouth needs to open wide, the tongue needs to driblet in the rima oris and gently extend over the lower gum ridge, and so information technology needs to cup or brand a "U" shape effectually the nipple. This constellation of movements is the root reflex. ³ Comparatively, the natural language thrust reflex lacks the additional elements needed to latch. In fact, the natural language thrust can immediately push an item back out of the baby'south mouth after a latch is established, which can be problematic for breast or bottle feeding.

Riley, vi months, thrusts a too-large seize with teeth of banana out of her mouth.

Why do some recommend waiting to showtime solids until the tongue thrust reflex disappears?

In the context of spoon-feeding, it'south functional to wait for the tongue thrust reflex to fade considering information technology'southward hard for baby to movement puree back to eat otherwise. Logically, this reflex would be a nuisance while spoon-feeding pureed food into a baby'south mouth. As the spoon touches the tongue tip, the natural language protrudes out, pushing all the puree out of the mouth. Baby doesn't have a chance to larn how to motility the food back to swallow because it all ends upwardly on their chin. Some spoon-fed babies learn to button the tongue on the spoon and suck the puree off, which is the same pattern used with a canteen.

Additionally, there is a misconception that a baby is non set up to swallow food until the thrust disappears, but that recommendation is not rooted in bear witness. Swallowing is a deep brainstem reflex, which is how babies know to swallow purees after using the same bottle-sucking blueprint described to a higher place. ^four Babies exercise not have to learn how to swallow.

Every bit with many suggestions in baby feeding, at that place is no clear rationale for the recommendation to expect for solids until the tongue thrust disappears.

Why should we not look for the tongue thrust reflex to disappear before starting solids?

Purees don't accelerate a baby's chewing skills in a meaningful mode. In fact, at that place is a disquisitional window between half-dozen to ix months of age where you must take a leap and give baby something chewable to consume then they learn to chew. Babies who only eat purees during this disquisitional window are at heightened adventure for poor chewing and picky eating as children. ⁵

Until the day baby tries solid foods, baby has used a single oral motor design to eat: a sucking blueprint. In the weeks leading up to starting solids, babe develops important gross and fine motor skills to support learning to consume; however, there is lilliputian to no shift in infant's oral motor patterns to make them all of a sudden more coordinated with chewing.

Babies demand chewable foods to learn how to chew and the tongue thrust reflex offers some level of protection while baby is developing the skills to move food safely around the mouth.

Oral-motor skill development when starting solids with finger foods

When starting finger foods, baby learns a new set of movement patterns and gains efficiency and coordination to chew and swallow solids safely. As the natural language thrust reflex integrates (usually between 4 to seven months), babies don't automatically know other oral motor patterns. They still need to break the dominant motor pattern of moving the natural language exclusively forwards, backward, and sucking.

There are iii dominant reflexes in play when infant starts solids:

• Tongue thrust reflex
• Natural language lateralization reflex
• Gag reflex

These reflexes help babies learn new movement patterns necessary to eat while staying safe.  All babies accept to acquire these new patterns, whether starting with finger foods at 6 months or starting with purees and moving to finger foods later. These reflexes also help the brain build a "mental map" of the mouth, allowing babies to gain more control, and effigy out how to move, chew, and swallow food accordingly and confidently.

Tongue thrust

While a strong tongue thrust reflex often prevents a spoonful of purees from entering the mouth, it helps self-feeding babies learn about nutrient. When a baby holds food while touching the lips and forepart of the tongue, the tongue automatically sticks out and explores the food by licking it. When babies put food in their mouth, they frequently override the tongue thrust by controlling the activeness of putting food in their mouth and by placing longer/bigger pieces of food towards the side of the mouth, triggering the tongue lateralization reflex.

Importantly, a lingering natural language thrust can also be helpful in pushing as well-large pieces of nutrient in the mouth forward and out, an additional protective layer to guard confronting choking.

Tongue lateralization reflex

Babies are born with the tongue lateralization reflex, which is present until well-nigh 9 months of age. When you bear on the side of the baby's tongue, it darts to that side. This reflex causes the tongue to motion sideways towards the stimulus in the rima oris to touch, lick, and explore whatever touches the tongue. ⁶

Maeve, 4 months, teethes on an infant toothbrush.

Observe when you chew food: your tongue moves sideways to push button food toward your molars for chewing. That'due south tongue lateralization merely, for you, it's non a reflex anymore—information technology'southward an established motor design your brain uses to motion and chew food.

Cocky-feeding stick-shaped pieces of food engages tongue lateralization and helps baby larn the building blocks of moving food in the rima oris. The more the tongue learns to motility side to side, the more the frontwards/backward pattern (tongue thrust) diminishes.

Gag reflex

Another layer of protection is the gag reflex, which besides helps continue food towards the forepart of the mouth. Together, the tongue thrust and gag help push any poorly chewed food back out of the mouth.

Must babies lose their tongue thrust reflex before starting solids?

No. In fact, at that place are distinct benefits to starting finger foods when babe however has the natural language thrust reflex.

Be mindful that if you lot plan to beginning past spoon-feeding purees, most of the food will finish up on babe's chin with a natural language thrust reflex in place. This doesn't mean baby doesn't like it; it but ways they don't have the skill to move past the natural language thrust just even so.

Additionally, if you offering exclusive purees for more than a few weeks, it's likely the tongue thrust reflex will diminish before offering finger foods. This simply means that baby will likely rely on the gag reflex as the primary way to motility food forrard and out of the mouth while learning to chew rather than the tongue thrust to button nutrient out apace.

To recap:

• The tongue thrust reflex is beneficial for oral motor development and learning to eat finger foods.
• The natural language thrust offers multiple layers of protection to a young baby:
  • Pushes nutrient (and objects) out of the mouth
  • Keeps the airway clear
  • Protects against choking
• Exploring solid foods with the oral cavity is critical to build a mental map of the oral cavity. Every bit things affect the inside of the mouth, the brain slowly "draws" a map.
• The tongue thrust and gag reflexes keep food forwards in the rima oris, protecting the throat from unchewed food that isn't ready to swallow.
• When babies outset solids with a tongue thrust reflex in place, they larn how to override the dominant tongue thrust blueprint and movement the tongue in new directions using the tongue lateralization reflex.
• Self-feeding stick-shaped pieces of food engages tongue lateralization and helps infant learn the building blocks of moving food in the oral cavity.

As pediatric feeding specialists with all-encompassing grooming in oral motor skill development, clinical feel working direct with thousands of infants to develop oral motor skills to eat solids and observing typically developing babies as they acquire to eat, we want to share our understanding and the importance of the tongue thrust reflex for helping a baby learn to chew. We acknowledge that our conclusions are based on clinical experience and ascertainment, simply we included literature when available.

Kary Rappaport, OTR/50, MS, SCFES, IBCLC

Kimberly Grenawitzke, OTD, OTR/L, SCFES, IBCLC, CNT

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1. Morris, South. East., & Klein, One thousand. D. (2000). Pre-Feeding Skills: A Comprehensive Resource for Mealtime Development (2nd ed.). Pro Ed.
2. Watson Genna, K. (2017) Supporting Sucking Skills in Breastfeeding Infants (3rd ed.). Jones and Bartlett Learning, Burlington, MA.
3. Watson Genna, Chiliad. (2017) Supporting Sucking Skills in Breastfeeding Infants (3rd ed.). Jones and Bartlett Learning, Burlington, MA.
4. Miller, J. 50., Sonies, B. C., & Macedonia, C. (2003). Emergence of oropharyngeal, laryngeal and swallowing action in the developing fetal upper aerodigestive tract: an ultrasound evaluation. Early Human Evolution, 71(i), 61–87. https://doi.org/10.1016/s0378-3782(02)00110-x
5. Northstone, K., Emmett, P., & Nethersole, F. (2001). The result of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. Periodical of Homo Nutrition and Dietetics, 14(1), 43–54. https://doi.org/ten.1046/j.1365-277x.2001.00264.10
6. Morris, S.E. & Klein, M.D. (2000). Pre-Feeding Skills: A Comprehensive Resources for Mealtime Development (2nd ed.) Pro Ed.

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