Tongue Thrusting in Infants: What's Normal, What's Not, and What to Do

Every healthy newborn is born with a tongue thrust reflex — and that's a good thing. It's the same reflex that helps babies push away anything that isn't food, prevents them from choking, and makes nursing and bottle feeding possible in the first place. 

When parents notice their baby sticking their tongue out, pushing food away, or thrusting their tongue forward repeatedly, it's almost always this normal reflex at work. The reflex naturally fades between 4 and 6 months of age. 

The concern arises when it doesn't — when tongue thrusting continues past infancy, becomes a habit, and starts affecting how a child eats, speaks, and how their teeth and jaw develop. 

This guide helps you understand what's normal at each stage, what signs to watch for, and when it's time to bring your pediatric dentist or pediatrician into the picture.

What Is Tongue Thrusting in Infants?

Tongue thrusting — also called the extrusion reflex — is a protective reflex all healthy babies are born with. When something touches the front of a baby's mouth or tongue, the tongue automatically pushes forward and outward. This reflex serves two critical functions in the newborn period: it helps babies latch onto the breast or bottle, and it prevents choking by pushing non-liquid objects out of the mouth before they can be swallowed.

This is why newborns and young infants stick their tongues out frequently, push pacifiers out of their mouths repeatedly, or spit out purees when solid foods are first introduced. None of this is a problem — it's exactly what the reflex is supposed to do.

The reflex begins to naturally diminish around 4 months and is typically gone by 6 months. This timing coincides with when babies become developmentally ready to start solid foods. If you notice your baby pushing food away with their tongue at 4 months, that's the reflex telling you they're not ready yet — not a feeding problem.

The term tongue thrust (without the word "reflex") refers to the habit that develops when this forward tongue movement persists beyond infancy, becoming part of the way a child swallows, speaks, or holds their tongue at rest. This is what can cause dental and speech problems over time.

How Is Tongue Thrust Diagnosed?

Tongue thrust is typically identified by a pediatric dentist, pediatrician, or speech-language pathologist. The assessment involves observing how the child swallows, speaks, and holds their tongue at rest. Your provider may ask your child to swallow while they watch the tongue position, or ask them to say specific words where tongue thrust produces characteristic sound substitutions — for example, "say" pronounced as "thay."

Your pediatric dentist is often the first to notice the dental signs of tongue thrust — particularly an open bite or spacing developing between front teeth — during a routine checkup. This is one of the reasons regular dental visits starting from age 1 are so valuable.

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How Is Tongue Thrust Treated?

The good news is that tongue thrust is very treatable, and many children resolve it with relatively straightforward interventions:

• Watchful waiting — for children under age 4 who show signs of tongue thrust without significant dental consequences, the approach is often to monitor while addressing any contributing factors (pacifier weaning, allergy management) and reassess
• Myofunctional therapy — a speech-language pathologist or orofacial myologist teaches the child exercises to strengthen the tongue and train it to rest in the correct position on the roof of the mouth. Sessions are typically weekly, with home exercises practiced daily. Most children see significant improvement over several months
• A tongue crib — an orthodontic appliance fitted by an orthodontist that creates a physical barrier preventing the tongue from thrusting forward. Worn for 6–12 months, it effectively retrains the tongue position and is most commonly used in children aged 8–12
• Addressing the root cause — if tongue thrust is related to chronic mouth breathing, treating the underlying cause (allergies, enlarged tonsils, adenoids) is essential. If tongue-tie is contributing, a frenectomy may be recommended
• Orthodontic treatment — if tongue thrust has already caused dental misalignment, braces or other orthodontic appliances can correct the bite after the tongue thrust habit has been addressed

How to Prevent Habitual Tongue Thrust

Not all tongue thrust can be prevented, but these steps reduce the risk significantly:

• Wean pacifiers and bottles by age 2–3 — the longer a child uses these, the more the tongue is trained to rest in a forward position
• Discourage thumb sucking — if your child has a thumb-sucking habit, the earlier it's addressed, the better. Your pediatric dentist can help with strategies
• Address chronic mouth breathing — if your child consistently breathes through their mouth, has chronic congestion, or snores, talk to your pediatrician. Treating underlying allergies or evaluating tonsil and adenoid size can make a significant difference
• Start dental visits early — regular visits from age 1 allow your pediatric dentist to monitor tongue posture, swallowing patterns, and early dental signs of tongue thrust, and to refer you early if needed

Is My Baby's Tongue Thrusting Normal? An Age-by-Age Guide

Newborn to 4 Months — Normal and Expected

At this age, tongue thrusting is completely normal and protective. Your baby will push their tongue forward when anything touches the front of their mouth. They will spit out pacifiers, reject spoons, and may look like they're "spitting out" milk during feeding — though this is usually just the natural rhythm of the reflex.

What's normal:

• Frequent tongue protrusion
• Pushing objects out of the mouth
• Tongue visible during feeding

What to watch for:

• Difficulty latching
• Painful nursing
• Poor weight gain
• Clicking sounds during feeding — these may indicate tongue-tie rather than a tongue thrust issue and warrant evaluation

4 to 6 Months — The Reflex Should Begin Fading

Around 4 months, you'll notice the reflex becoming less pronounced. This is the developmental window when babies begin to show interest in what you're eating and may seem ready to try food — but the fading reflex is the true indicator of readiness, not age alone.

What's normal:

• Gradually less tongue protrusion
• Beginning to tolerate a spoon touching the lips

What to watch for:

• If the reflex seems just as strong at 6 months as it was at birth — meaning your baby still pushes everything out reflexively — mention it at your next well-child visit

6 to 12 Months — Reflex Should Be Gone

By 6 months, the tongue thrust reflex should have largely resolved. This is when most families begin introducing purees and soft solids. The tongue should now be able to move food to the back of the mouth for swallowing rather than pushing it forward.

What's normal:

• Occasional tongue protrusion when discovering new textures
• Some messiness with early solids

What to watch for:

• Consistent pushing of all solid food out of the mouth past 6–7 months despite repeated exposure
• Gagging excessively or refusing all textures beyond purees at 9–12 months — these may be signs of a feeding issue or persistent tongue thrust worth evaluating

12 Months and Beyond — Habitual Tongue Thrust Becomes a Concern

If tongue thrusting continues as a habitual pattern beyond age 1 — meaning the child pushes their tongue forward during swallowing, speech, or at rest even when there's no food or object involved — it has transitioned from a normal reflex to a habit worth monitoring. At this stage, it may begin to affect how teeth develop.

Why Do Some Babies Develop Habitual Tongue Thrust?

When the tongue thrust reflex doesn't naturally resolve, or when it resolves but the forward tongue habit is reinforced, several factors may be involved:

• Prolonged pacifier or bottle use — an object constantly in the mouth trains the tongue to rest in a forward position. Using pacifiers and sippy cups beyond age 2–3 is one of the most common contributors to habitual tongue thrust
• Thumb sucking — the sucking motion reinforces the forward tongue position in the same way
• Chronic nasal congestion, allergies, or enlarged tonsils and adenoids — when a child can't breathe comfortably through the nose, they breathe through the mouth instead, which encourages the jaw and tongue to drop forward. Mouth breathing and tongue thrust are closely linked
• Tongue-tie (ankyloglossia) — restricted tongue movement caused by a tight frenulum can prevent the tongue from resting in the correct position on the roof of the mouth, contributing to a thrust pattern during feeding and swallowing
• Anatomical factors — a narrow upper jaw or crowded teeth leave less room for the tongue to rest correctly, which can encourage forward positioning
• Neurological conditions — conditions that affect muscle tone and coordination, such as Down syndrome, cerebral palsy, and some developmental delays, are associated with higher rates of tongue thrust

What Are the Signs of Tongue Thrust in Infants and Young Children?

As your child grows, here's what tongue thrust looks like in practice:

During feeding and eating:

• Food consistently falls out of the mouth during eating
• Difficulty managing solid textures beyond purees
• Drooling more than expected for age

During swallowing:

• The tongue visibly pushes forward between the teeth when swallowing
• A reverse swallow pattern — where the tongue pushes forward instead of pressing against the roof of the mouth

At rest:

• The tongue rests between the teeth or protrudes slightly when the mouth is closed
• Frequent open-mouth posture

In speech (older children):

• Difficulty with "s," "z," "sh," and "j" sounds
• A lisp

In dental development (if untreated long-term):

• Open bite — front teeth don't meet when the mouth is closed
• Spacing between front teeth
• Protruding front teeth (overjet)

Does Tongue Thrust Affect Teeth and Jaw Development?

Yes — if it persists long enough. The tongue exerts significant force on teeth with every swallow. A typical person swallows approximately 500 to 1,000 times per day. When the tongue pushes forward against the teeth during every swallow, that repeated pressure gradually moves teeth in that direction.

The most common dental consequence is an open bite — where the upper and lower front teeth don't touch when the mouth is closed because the tongue has pushed them apart over time. Tongue thrust can also contribute to overjet (protruding front teeth), spacing between teeth, and jaw development issues.

The key is timing. A tongue thrust habit in a 2-year-old is much less concerning than the same habit in a 6-year-old with permanent teeth beginning to erupt. Early identification allows early intervention before dental consequences develop.

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Frequently Asked Questions

What is tongue thrusting in infants?

Tongue thrusting in infants refers to the normal extrusion reflex all babies are born with, which causes them to push their tongues forward when anything touches the front of their mouths. This reflex protects newborns from choking and makes feeding possible. It typically fades between 4 and 6 months of age. When the forward tongue habit persists beyond infancy and becomes part of how a child swallows or speaks, it is called habitual tongue thrust and can affect dental and speech development.

Why does my baby stick their tongue out?

Babies stick their tongues out primarily because of the tongue thrust reflex, which is normal and protective in the first 4–6 months of life. After 6 months, tongue protrusion may also simply be a form of exploration and communication. If your baby is consistently sticking their tongue out past 6 months during swallowing or at rest, mention it at your next well-child visit.

When does the newborn tongue thrust reflex go away?

The tongue thrust reflex typically begins to fade around 4 months and is generally gone by 6 months. This is the developmental milestone that signals readiness for solid foods — when the reflex has faded enough that the tongue can move food to the back of the mouth for swallowing rather than pushing it forward.

Is tongue thrust in babies serious?

In infants under 6 months, tongue thrust is completely normal and not a concern. After 6 months, if the habit persists and begins affecting swallowing, feeding, or later speech and dental development, it warrants evaluation. The earlier it's identified, the easier it is to address before dental or speech consequences develop.

Can tongue thrust go away on its own?

Many children naturally outgrow tongue thrust by age 4–5, particularly when contributing habits like pacifier use are addressed. However, children who haven't outgrown it by age 4 are less likely to do so without intervention. If tongue thrust is affecting speech or dental development, treatment is recommended rather than waiting.

What causes tongue thrust in babies?

Tongue thrust in babies starts as a normal reflex. It becomes habitual when it's reinforced by prolonged pacifier or bottle use, thumb sucking, chronic mouth breathing due to allergies or enlarged tonsils, tongue-tie, or anatomical factors like a narrow jaw. Neurological conditions that affect muscle tone also increase the likelihood of persistent tongue thrust.

How is tongue thrust treated in children?

Treatment depends on the child's age and the severity of the habit. Options include myofunctional therapy, a tongue crib appliance, addressing contributing causes like mouth breathing or tongue-tie, and orthodontic treatment if dental consequences have already developed. Many children treated between ages 8 and 12 achieve excellent outcomes.

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