Part 3 of 3-Part Series on Lisps, Tongue Thrust and Prevention
Here we are at Part 3 of this 3-Part series on lisps and tongue thrusts. If you’ve read part 1 My Kid Can’t Say his S & Z Sounds: What is a Lisp and part 2 Tongue Thrust: What is it and Why Should I Care? then you know what these are, what to look out for, possible causes and how/when to treat. Now, let’s talk PREVENTION.
Infant/Toddler Feeding/Drinking Tips
From a pure PREVENTION perspective, one of the best things we parents can do to set our children up for success with oral and speech development is to be very purposeful and mindful about bottle and sippy cup use, as well as oral habits like pacifiers and thumb/digit sucking.
Remember that a true tongue thrust includes an ‘infantile’ swallow pattern. All infants begin life suckling with this infantile swallow pattern where their tongue first protrudes forward in their suck/swallow pattern. However, this should quickly (and naturally) evolve with infants (with gradual less protrusion and more retraction) until around age 3, when the child should have developed a ‘mature’ swallow pattern with NO tongue protrusion on a swallow. For those kids (and many adults) who exhibit a tongue thrust, they never developed the correct mature swallow pattern and their tongues continue to protrude on the swallow (often as well as at rest and/or in speech).
Bottles and many sippy cups reinforce this infantile suck/swallow pattern. Therefore, my recommendation is to eliminate bottles as close to a child’s 1st birthday as possible and to avoid the hard spout sippy cups altogether. Transitioning to a sippy cup (with a hard spout), essentially does the same thing the bottle would do, with the tongue being forced down below the spout, as opposed to lifting up and retracting back into the oral cavity which is what we want for a mature suck/swallow pattern. So what’s a parent to do?? I certainly realize that a 12 month old may not be ready for an open mouth cup, (though I would start practicing this well before a child’s 1st birthday with your help, and transition to this as soon as possible) so my suggestion is to transition them to a straw or recessed lid cup. Drinking from a flexible straw is a great transition for kids as straw drinking encourages the tongue elevation and retraction we want when sucking in the liquid. Cups with a recessed lid (not a spout) are also good as they require good lip protrusion and a retracted tongue position to suck in the liquid. Here are a few suggested brands for training cups (in no particular order!):
Note that if you want to ‘teach’ straw drinking to your little one (as early as 8-9 months), there is a helpful protocol for how to do this (see below). The overriding idea is to eventually cut the straw length down so that there is just enough straw to go past the lips and not touch the tongue tip or teeth. This encourages good lip protrusion, tongue elevation and tongue retraction to pull in the liquid. In other words, it gets the tongue where we want it to be! See the link below for the straw protocol taken from Raising a Healthy Happy Eater by Melanie Potock and Nimali Fernando.
In infancy, our little babes have a strong suckling reflex and often need thumbs or pacifiers for self soothing and to satiate that need to suckle. That’s A-OK! However, we need to keep an eye on how long this habit continues. Many children will stop on their own between the ages of 2-4 and the American Academy of Pediatrics recommends intervening if they haven’t stopped by age 5. I am of the mind that the sooner we can eliminate this habit, the better, as we know that prolonged finger or pacifier use can impact the shape of the mouth (palate) and teeth and can also interfere with a child’s ability to develop a correct swallowing pattern. I am also of the mind that the longer a child (or anyone) has a particular habit, the harder it is to eliminate so why not start early? Again, the idea is early prevention to lessen the likelihood of problematic oral development down the line. I know with my own toddler, who LOVED his ‘passy’ (as we called the pacifier), I weaned him off by @ 2 years old. By that time he had good language skills so we could talk through the steps, gradually lessen his time with the pacifier over a few months until finally, he threw his last chewed up pacifier in the garbage himself (knowing we didn’t have any more in the house).
Pacifiers are often easier to eliminate due to the fact that it is a separate object and must be present/accessible to be in use (as opposed to the thumb that is always accessible and harder to eliminate!). This can be a lengthy topic so I will point you to a few great resources if you’re looking for ways to eliminate this habit with your toddler-elementary aged child. It’s important to note that going ‘cold turkey’ is generally frowned upon and that children usually need a kind, gentle, gradual approach that works for them.
If you do have a child with one of these oral habits who also exhibits a lisp or tongue thrust, it is very important to address the oral habit first. If that oral habit is reinforcing a tongue thrust pattern (highly likely) then anything you do through therapy (developing new motor patterns) or through orthodontia (if there are issues with dental development) can be UNDONE by that oral habit. Again, seeking a professional for the particular area(s) of concern can help you through these steps (i.e. speech pathologist, orofacial myologist, orthodontist).
Underlying Medical Conditions
Remember that if we’re able to identify a tongue thrust EARLY in our children (i.e. open mouth posture, tongue protruding between teeth, mouth breathing), we need to rule out any medical conditions that may be underlying this. Referring back to my Part 2 blog: Tongue Thrust: What is it and why should I care? We know that medical or structural anomalies could be the cause (like enlarged tonsils, adenoids, chronic allergies/upper airway constriction, tongue-tie). So our first step would be to go to your medical team (pediatrician, ENT, dentist) to identify if any of these things are at play and if so, to address these medical conditions FIRST. While a tongue thrust may have developed already due to one of these medical/structural conditions, identifying this EARLY and fixing this underlying issue is a necessary first step and may prevent long-term dental, speech or psychosocial problems down the road.
While there is no guarantee that following some or all of these prevention tips will prevent a lisp or tongue thrust, they will certainly lessen the likelihood of long term issues arising and will help set your kiddo up for success with oral development (swallowing, speech, dentition and overall shape of oral structures)! Feel free to chime in below if you’ve had success (or not!) with some of these resources with your child.