Monday, October 25, 2010

On Tongue Protrusion

Matthew and I went to the zoo last month. We were looking at the elephant when I heard a young boy ask his mother, "Why does he keep his mouth open?" I looked over and he was looking at Matthew. It was an innocent question. Matthew's mouth was open. The boy was probably around 8 years old. I didn't hear his mother answer his question and saw her trying to redirect his attention to the elephant. I just smiled at them but didn't say anything else.

I've heard stories of encounters where strangers would actually rudely tell a toddler (or even a baby) to keep his/ her tongue in, as if the child was doing it on purpose. Our encounter wasn't like that. Otherwise, my blood would've been boiling and I would have definitely said something.

tongue protrusion

Looking back, maybe I should have casually said, "Oh, he doesn't keep his mouth open all the time" or "He's just so amazed by the elephant." It might have been better than saying nothing. But at that time I didn't think there was anything I could say that wouldn't lead into explaining low muscle tone, jaw stability, large tonsils and Down syndrome to strangers at the zoo.

It has been commonly thought that tongue protrusion was due to an enlarged tongue. There are many articles online that still cite that. An online article titled "Tongue Protrusion" by Karen Henderson, who is a Senior Speech & Language Therapist at Cheeverston House, Tempelogue, Dublin, has an extensive list of factors that may contribute to tongue protrusion. It also acknowledges that every individual with Down syndrome is affected by a different combination of these factors. No one is the same. She also suggests several simple activities to increase tone and awareness around the mouth.

mouth open

Encouraging Tongue Retraction
Several people, including Matthew's Early Intervention therapists, have observed and commented that Matthew is able to keep his tongue in and mouth closed most of the time. Yet in my mind, having his mouth open for perhaps 30% to 40% of the time each day is still an indicator that he needs to increase his overall tone, jaw stability and awareness.

I personally do not believe that Matthew has enlarged tongue. I think his large tonsils are also a contributing factor to his tongue protrusion. I don't know this for a fact but this is what I speculate.

tongue out
I did (and do) many things to encourage tongue retraction including:
- breastfeeding when Matthew was a baby as much as I could. I nursed him (but not exclusively) for about 8 or 9 months until my body decided it couldn't keep up anymore. He also drank milk from a Dr. Brown's bottle.
- facial massages to stimulate the nerves in the face.
- tapping my finger on his tongue when it was out to make him aware of it. He was less than a year old. It didn't work all the time though.
- asking him "Where's your tongue?" to encourage him to point to it and in effect, pull it back in his mouth. This was when he knew what "tongue" was.
- using a z-vibe and Jiggler to stimulate the mouth muscles.
- using straw cups whenever possible to encourage lip closure, which helps with oral-motor tone.
- prompting him to say "mmmm" when we were working on the m sound in speech therapy.
- increasing his overall tone with various fine motor and gross motor activities.
- getting him to smile or laugh a lot. He almost always smiles with his tongue in plus it's just nice to see him smile or hear him laugh.

There are so many suggested activities to encourage tongue retraction. An occupational therapist and speech therapist will have lots of ideas. There are even programs like the "Horn Hierarchy" and "Straw Hierarchy" available at Talktools if one is willing to spend the money.

It's an ongoing effort. I imagine it will get easier as he gets older and more aware of whether his mouth is open or not and if his tongue is in or out.

Related post:
TalkTools Horn Kit
TalkTools Straw Hierarchy Kit


Cathy said...

Innocent questions from children don't bother me. Ignorance by adults...well, that's another story.

Lily doesn't have much of a problem with tongue protrusion. I too, try to make her aware of it when it happens. It usually happens when she's concentrating on her "Signing Time" videos or when she's really tired. We will be starting on the Horn Hierarchy if EI ever sends them out. That's a whole other We do oral motor exercises daily which include massaging, the Z-Vibe, etc.

Great post, as usual! :0)

Adrienne said...

So I wonder if it really is a bigger tongue or just a smaller mouth and normal sized tongue. I thought the latter and it seems to make more since. Everything else on our kids is smaller so why on earth would the tongue be the only things that's larger??!! For some reason I get offended when medical professionals say they have larger tongues-it just doesn't make since.

Anyways, thanks for the post and I'm glad your encounter wasn't necessarily a bad one.

Me said...

I'd always been told that it's a regular sized tongue--with a smaller mouth--plus the lower tone can affect things too (some of my students also had issues because of sinus blockage--which made it really hard to breath without their mouth open). But--I did notice that most of my students, by middle school, were better at remembering (except when ill). That was my observation only though--

Anna said...

About a week after we got home from adopting little G I went out for lunch with friends. One is a speech therapist and she was asking why I told G to put her tongue back in her mouth. I was only doing what the school told us to do with her mind you. I explained that and she said that Graces tongue was too big for her mouth. ANother friend jumped in and asked why if it was too big then why G put it away upon command. It was awkward. I didnt know how to react since I havent been a parent with a child that has down syndrome long, yet I have an almost 5 year old. I would hate to be doing something that would harm her or be uncomfortable and explained this to my friend. My biggest worry would be her to fall with her tongue hanging out and it get bitten. She has eyesight problems so that would be a very concievable possibility....

M.Hilton said...

Great to hear what you've been doing on this issue - thanks for the post :)

JC said...

This was great! Thanks for posting it :)