Ask a Therapist: Tongue Thrust

I have been working with a 2, almost 3, year old patient for 10 months. He initially came to me with delayed speech -- one-syllable words with limited vocabulary and reduced intelligibility. He now uses 5-6 word sentences spontaneously, intelligibility has increased, he has added new speech sounds and errors are primarily /th/ and blends. We did a lot of oral strengthening as he was a drooler and that has improved. He had a very restricted lingual frenum, corrected in December. He also has an inferiorly attached upper labial frenum, which limits some range of motion in upper lip movement. My concern:   he continues to exhibit a suckle drinking pattern. We have introduced the straw program, but I can’t get past the first one because of the suckle. Is he too young? Should that improve with the increased range of motion now that he's had the lingual frenectomy? He is at a good point with language and articulation, so I was wondering if there is something I can do to make a difference?

Tongue thrusting should be fully remediated by 24 to 36 months, so suckling at this age is atypical. I would refer the patient to an oral surgeon or ENT to seek medical advice on the frenums. It sounds to me like there may be a structural issue.

Sara Rosenfeld-Johnson wrote an article titled, “Effective Exercises for a Short Frenum,” on how to stretch the frenum (sublingual) with the use of bite blocks which I would recommend you read. See if you can get the client to touch the upper back molar with the tongue tip. If not, you can try Sara's exercises. I do this often to prove that therapy alone may not work. Sometimes you can stretch it, but it depends on length, color and location.

Robyn Merkel-Walsh

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