Eliminating Tongue Thrust

In conversation during therapy, six year old Nikki could accurately say S and Z words like “Stephanie”, “sorry” and “pretzels“.  The second her mom joined us to wrap up our session and discuss homework, Nikki immediately lost correct tongue placement, exhibiting a tongue thrust.

Oral placement therapy had previously been addressed.  Nikki’s jaw, lips and tongue were strong and stable to support all speech sounds.

Nikki’s mom found it frustrating to frequently remind Nikki to use our techniques, and Nikki didn’t enjoy the nagging.  What to do?  We added Sticky Tape (AKA Sticky Spot)!

Sticky Tape acted as a tactile reminder.  Nikki’s tongue tip was naturally drawn to the tape.  We also found when Nikki’s mouth was at rest, she did not exhibit her classic open mouth / tongue protrusion posture.  Sticky tape helped to habituate appropriate tongue and lip position.

Sticky Tape is a smooth, thick, medical grade tape.  We fixed a small square (about 2cm x 2cm – sometimes a slightly bigger size is more effective) just behind, but not touching, the two top central teeth (upper central incisors) at midline on the hard crescent shaped area (alveolar ridge).

This spot might also be called the special spot, secret spot or as Robyn Merkel Walsh calls it, The Smile Spot.

The tape may be purchased from Active Forever or flavored Sticky Spot (cherry, bubble gum, mint, chocolate, etc.) may be purchased from Myo Made Easy.

When I asked Rhonda Collier of Myo Made Easy what the Sticky Tape is made of, she wrote:

My prior research into concerns about possible allergens revealed that the content of the product is free of common irritants or vegan objections. The main ingredients are pectin (if you’ve ever made jam you know how sticky this is!) and fruit cellulose which is technically the cell walls of plant fiber. We use similar flavorings as used in orthodontic offices to flavor impression molds.

The unflavored tape from activeforever and the tape from myomadeeasy are both Stomahesive Skin Barrier made by ConvaTec.  Myomadeeasy just adds flavoring.

Children enjoy the option of the flavors, but the flavor wears off quickly.

I found Sticky Tape to work most effectively when it was applied after meals.  The tape may dissolve, fall out on its own, or it can be carefully removed.  Some children don’t mind eating with the tape in place.  Generally, three small squares are used each day.

The Sticky Tape sticks best when a child swallows saliva first.  Next, dry off the alveolar ridge with a small piece of paper towel.  Take the small square of Sticky Tape you have previously cut and hold the tape in the correct place while you sing a song or tell your child about your day.  After about a minute, the tape should adhere.

In addition to using the Sticky Tape, Nikki and her mom followed the plan below for homework:

Tongue Tip Placement Reminders:

1. Nikki should follow the rules below for swallowing all food and liquid.  These rules are adapted from Sara Rosenfeld Johnson’s Therapeutic Straw Drinking / Single Sip Swallow technique:

A. Place the top ¼ inch of the straw between your puckered lips at midline (or if you drink from an open cup, lips only on the rim (no teeth)
B. Sip in the liquid until you feel it in your mouth
C. Remove the straw but do not swallow the liquid
D. Close your lips as you put your tongue tip up to the secret spot
E. Freeze
F. Swallow the liquid without moving your tongue tip
G. Open your mouth, your tongue tip should still be on the secret spot

2. Tongue Tip Elevation Tool – Please watch Sara’s video to understand how to use this tool.

3. Tongue Tip Elevation with Cheerio – Place a Cheerio on the secret spot. Nikki should place her tongue tip into the center of the Cheerio. Her jaw should be relaxed and open about one inch.  She should hold the Cheerio with the tip of her tongue for 50 seconds, 3 times per day.

Traditional Carryover Tasks:

1. Nikki should read wordless picture books aloud.  These books will create structure when trying to produce accurate S’s and Z’s.  Describing funny pictures will do the same.

When Nikki is turning a page, encourage her to self-monitor.  Encourage Nikki to point to a drawn out “happy” or “sad” face to let you know how she thinks she did.

2. Talk about using accurate S’s and Z’s before school, when she gets home, and before you practice.

3. Have a focused period of time (about 15 minutes) each day where Nikki is concentrating on using S and Z properly in conversation. Set a timer, as necessary.

4. Choose high frequency target words that she must always say correctly (e.g., please, strawberry, school).

5. Use a mirror for visual feedback or a video camera to record a sentence or two Nikki says.  Have her critique her own speech.

6. Encourage Nikki to speak slowly all the time.

Additional Notes / Tips:

Nikki has a bad habit of clenching her jaw when she tries too hard to say s/z or when she fatigues. Encourage her to relax her jaw if this occurs.

Watch out for words that trip her up: S at the beginning and at the end of the same word (e.g., socks) – and TH blends close to S and Z (e.g., the zebra).

We also found it helpful to recruit Nikki’s teacher to help with carryover.  Nikki and her teacher made up a private hand signal.  If Nikki mispronounced S or Z, her teacher made eye contact with her and touched her own nose.  Nikki knew to slow down and say s/z correctly. Her teacher also gently reminded Nikki to use her special swallow at snack and lunch time.

Additionally, a few therapy sessions in the outside world (e.g., grocery store, library, toy store) using our techniques with store employees helped to solidify our work.

This summer, Nikki is happily using correct productions of S and Z in conversational speech without Sticky Tape or reminders!

Stephanie Sigal is a New York City speech therapist working on Manhattan’s Upper East Side.  She works with children with articulation and language delay.  You can read more about her work at sayandplayfamily.