What does lateralization of tongue mean?

While eating comes naturally for some infants and toddlers, it is actually one of the most complex activities we engage in on a daily basis. Eating requires the use of all of our sensory systems including tactile, visual, olfactory, gustatory, auditory, interoception, proprioception, and vestibular. Not only does eating require postural control to maintain an upright seated position, but it also requires coordination of the lips, cheeks, tongue, and teeth. Eating requires a progression of food manipulation, from sucking to mashing to munching, and ultimately using a rotary chew to eat complex foods and textures.

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Why is tongue lateralization important for feeding?
How is tongue lateralization tested?
What is lateral feeding?
What is tongue elevation?

As humans, we are born with certain reflexes that support our eating at an early age, and often integrate by age one. These reflexes include the rooting reflex, suckling reflex, and transverse tongue reflex. As these reflexes integrate, it is important that our children know how to carry out these oral motor skills on their own. We can help children develop the oral motor skills and motor patterns to bite, lateralize, chew, and swallow a variety of textures. This actually takes quite a bit of practice, and can sometimes even require some additional teaching. One of the best ways to support our children as they transition from liquids to solids is to support the development of tongue lateralization (moving the tongue from midline to the sides of the mouth). Below are some of the ways to support tongue lateralization development:

Suggested “Tools” to Support Tongue Lateralization:

Z-vibe (can be used with or without vibration)
‘P’ and ‘Q’ chewies
NUK Brush
Hard Munchables (a long, skinny, hard piece of food that won’t break in a child’s mouth):

Hard munchables are often introduced around 7-9 months of age, but can be used to help teach tongue lateralization at any age.
The goal of these food items is NOT to bite and chew them. The goal is for exposure and exploration! We want the child to move the item around their mouth to get their tongue moving by following it reflexively. Dipping hard munchables in a puree and encouraging your child lick the puree off is often a motivating task.
Examples: carrot stick, celery, beef jerky, frozen strip of pancake, lollipop, etc.

Frequently asked questions:

Should I let my child put toys in their mouth?

While we absolutely want our children to be safe, there are actually significant benefits to letting children explore and put safe toys in their mouths. This is one of the best ways for them to explore their world, especially before they are mobile. This can also provide exposure to a variety of tactile input, smells, and textures.

Why is my child spitting food out even though they are obviously hungry?

Oftentimes, children spit food out for several reasons. They may not have the oral motor skills to safely chew and swallow a food, or they may be overly sensitive to the taste or texture of a food. They may also be unsure of how to manipulate the food in their mouth.

Why does my child need to move their tongue if they are only eating purees?

Tongue lateralization is required to manipulate most food textures, and helps support developing a mature chewing pattern. Chewing actually helps to stimulate teeth growth and protrusion, as well as palate development. By practicing moving the tongue laterally before children are presented with a solid piece of food, children can safely practice and explore without the risk of choking.

How else can I help my child use their tongue more efficiently?

Start by eating with your child in front of a mirror so that they can see what their tongue and the food is doing. Parents can model what their tongues do while manipulating foods, chew with an open mouth, and use exaggerated tongue and chewing movements to help support their child’s feeding development. Don’t worry about manners just yet – skills come first!

Question: Do you have a tool to increase tongue protrusion and tongue lateralization?

We do! ARK's Oro-Navigator was specifically created to help individuals "get" the concept of tongue lateralization. It's very easy to use. Simply place the cuff on the side of the tongue and guide the tongue from one side of the mouth to the opposite side. Then repeat on the other side of the tongue. This allows the individual to feel what their tongue should be doing. Use a mirror for visual feedback so that they can see what their tongue is doing as well.

To establish the concept, you can also do trunk turning exercises. Sit on the floor with the child between your legs. Place items to the right and left side of the child (within their reach). Have the child take their right hand and reach over to the left side to get the item. Repeat to the other side. Have the parent do this with the child for home practice.

You can also stroke the sides of the tongue with the Probe or Z-Vibe to stimulate lateralization. Stroke one side five times, then the other. Or, you can alternate sides to simulate lateralization.

Another exercise for tongue lateralization: place the tip of the Probe or Z-Vibe inside the cheek area to one side. Have the child touch it with the tip of their tongue. Repeat to the other side. Do about 5 sets.

For tongue protrusion: if the tongue is too far back in the mouth, stroke the tongue from front to back to relax the tongue and have it come forward slightly.

All that being said, the need to increase both tongue protrusion and tongue lateralization raises a red flag for me. It sounds as if there is a larger problem at hand here, possibly ankyloglossia (tongue tie). A few factors to consider are the following:

• Can the individual extend his/her tongue OUTSIDE the mouth to lick an ice cream cone or lollipop? Or, does he/she position the food inside the oral cavity, compensating for the inability to extend the tongue for licking?

• Have the individual open his/her mouth wide and position the tongue tip up to the alveolar ridge (the piece of skin behind the upper front teeth). Can the tongue reach that spot? Is the individual closing the mouth in order to reach it?

• Is the individual speaking with a more closed mouth? Elevating the tongue to the alveolar ridge is how we produce the tongue tip sounds t/d/n/l/s/z. If an individual cannot properly elevate the tongue, his/her speech will be affected. Observe carefully, as the individual may be compensating by making these sounds with the tongue tip behind the bottom teeth instead.

Without seeing the child, it's difficult for me to accurately assess the situation. I would refer to a medical doctor such as a dentist or ENT, who can work in conjunction with an SLP to diagnose this case. If there is ankyloglossia, the parents will ultimately decide what they want for their child. I hope this information points you in the right direction.

All my best,

Debbie

Debra C. Lowsky, MS, CCC-SLP

Why is tongue lateralization important for feeding?

Tongue lateralization is required to manipulate most food textures, and helps support developing a mature chewing pattern. Chewing actually helps to stimulate teeth growth and protrusion, as well as palate development.

How is tongue lateralization tested?

Simply place the cuff on the side of the tongue and guide the tongue from one side of the mouth to the opposite side. Then repeat on the other side of the tongue. This allows the individual to feel what their tongue should be doing.

What is lateral feeding?

the mouth to the side for chewing. • Uses lateral tongue movements when food is placed on side of mouth; begins to. transfer food from center of tongue to side.

What is tongue elevation?

Tongue elevation exercise (known also as mewing) is a technique that is used to improve facial aesthetics and jawline. It is also a key exercise in Face Yoga and involves placing the tongue against the roof of the mouth while closing the lips (forming a lip seal).