Tongue Thrust and Starting Solids

A baby in a seated position and pink dress reaches for the camera. Text appears around her to describe readiness for solids, including the ability to sit, hold head upright, and show interest in food. And a red X near a drawing of a tongue sticking out to show that waiting for the tongue thrust to go away is not necessary before starting solids.

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

Preparing to start solids? Check out our guides and videos on how to start solids and prevent picky eating.

What is tongue thrust?

The tongue thrust, or extrusion reflex, is a reflex present at birth that persists until 4 to 7 months of age in typically developing babies.1 In young infants, the tongue thrust is stimulated by touching the tip of the tongue, causing the tongue to “thrust” or stick out of the mouth. A strong tongue thrust reflex causes the tongue to extend past the gums and lips; a tongue tie may cause some restriction.

Another reflex present 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 mouth before it pulls the breast or bottle into the mouth. Like the tongue thrust reflex, the root reflex is present until 4 to 6 months of age.2

Because of the tongue thrust and root reflexes, the forward thrusting of the tongue is a well-established and strong movement pattern by 6 months of age, even if the reflexes have integrated or disappeared.

Charlie, one month old.
Charlie, one month old.

What does the tongue thrust reflex do?

Interestingly, the evidence in this area is lacking; there is almost no research 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 primary functions of the tongue thrust reflex include:

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

Newborns and young infants have immature oral motor skills, poor head and neck control, and often lie 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 end 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 push things back out of the mouth when necessary. As the reflex fades and babies learn more coordinated tongue and finger movements, they can spit things out of their mouth as needed.

Some professionals feel the tongue thrust reflex is present to help babies stick out their tongue to latch at the breast, but we disagree with this theory. To latch, the baby’s head needs to turn towards the breast or bottle, the mouth needs to open wide, the tongue needs to drop in the mouth and gently extend over the lower gum ridge, and then it needs to cup or make a “U” shape around the nipple. This constellation of movements is the root reflex. 3 Comparatively, the tongue thrust reflex lacks the additional elements needed to latch. In fact, the tongue thrust can immediately push an item back out of the baby’s mouth after a latch is established, which can be problematic for breast or bottle feeding.

Riley, 6 months, thrusts a too-big bite of banana out of her mouth.

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

In the context of spoon-feeding, it’s functional to wait for the tongue thrust reflex to fade because it’s difficult for baby to move puree back to swallow otherwise. Logically, this reflex would be a nuisance while spoon-feeding pureed food into a baby’s mouth. As the spoon touches the tongue tip, the tongue protrudes out, pushing all the puree out of the mouth. Baby doesn’t have a chance to learn how to move the food back to swallow because it all ends up on their chin. Some spoon-fed babies learn to push the tongue on the spoon and suck the puree off, which is the same pattern used with a bottle.

Additionally, there is a misconception that a baby is not ready to swallow food until the thrust disappears, but that recommendation is not rooted in evidence. Swallowing is a deep brainstem reflex, which is how babies know to swallow purees after using the same bottle-sucking pattern described above.6

Maeve, 4 months, teethes on an infant toothbrush.

Notice when you chew food: your tongue moves sideways to push food toward your molars for chewing. That’s tongue lateralization but, for you, it’s not a reflex anymore—it’s an established motor pattern your brain uses to move and chew food.  

Self-feeding stick-shaped pieces of food engages tongue lateralization and helps baby learn the building blocks of moving food in the mouth. The more the tongue learns to move side to side, the more the forward/backward pattern (tongue thrust) diminishes.

Gag reflex

Another layer of protection is the gag reflex, which also helps keep food towards the front 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, there are distinct benefits to starting finger foods when baby still has the tongue thrust reflex.

Be mindful that if you plan to start by spoon-feeding purees, most of the food will end up on baby’s chin with a tongue thrust reflex in place. This doesn’t mean baby doesn’t like it; it just means they don’t have the skill to move past the tongue thrust just yet.

Additionally, if you offer 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 move food forward and out of the mouth while learning to chew rather than the tongue thrust to push food out quickly.

To recap:

  • The tongue thrust reflex is beneficial for oral motor development and learning to eat finger foods.
  • The tongue thrust offers multiple layers of protection to a young baby:
    • Pushes food (and objects) out of the mouth
    • Keeps the airway clear
    • Protects against choking
  • Exploring solid foods with the mouth is critical to build a mental map of the mouth. As things touch the inside of the mouth, the brain slowly “draws” a map.
  • The tongue thrust and gag reflexes keep food forward in the mouth, protecting the throat from unchewed food that isn’t ready to swallow.
  • When babies start solids with a tongue thrust reflex in place, they learn how to override the dominant tongue thrust pattern and move the tongue in new directions using the tongue lateralization reflex.
  • Self-feeding stick-shaped pieces of food engages tongue lateralization and helps baby learn the building blocks of moving food in the mouth.

As pediatric feeding specialists with extensive training in oral motor skill development, clinical experience working directly with thousands of infants to develop oral motor skills to eat solids and observing typically developing babies as they learn 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 observation, but we included literature when available.

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

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

  1. Morris, S. E., & Klein, M. 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, K. (2017) Supporting Sucking Skills in Breastfeeding Infants (3rd ed.). Jones and Bartlett Learning, Burlington, MA.
  4. Miller, J. L., Sonies, B. C., & Macedonia, C. (2003). Emergence of oropharyngeal, laryngeal and swallowing activity in the developing fetal upper aerodigestive tract: an ultrasound evaluation. Early Human Development, 71(1), 61–87.
  5. Northstone, K., Emmett, P., & Nethersole, F. (2001). The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. Journal of Human Nutrition and Dietetics, 14(1), 43–54.
  6. Morris, S.E. & Klein, M.D. (2000). Pre-Feeding Skills: A Comprehensive Resource for Mealtime Development (2nd ed.) Pro Ed.
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