Tongue-thrust reflex: what it is and when it fades

What the tongue-thrust reflex is

Young babies are born with a reflex that pushes their tongue forward when something touches their tongue or lips. Anything placed on the tongue, including food, gets pushed back out (EFSA). It’s called the tongue-thrust reflex or the extrusion reflex.

It’s one of several reflexes newborns have for feeding. The European Food Safety Authority (EFSA) describes these early reflexes as helping coordinate sucking, swallowing and breathing, and protecting a young baby from breathing in food or choking. That’s useful while a baby lives on milk alone, and it’s one reason babies under 4 months aren’t ready for solid food.

You’ll notice it most when you offer a spoon: the food goes in, and the tongue pushes it straight back out onto the chin.

When it fades

The reflex usually fades between about 4 and 6 months (CDC MMWR, EFSA). EFSA notes that this age range is an estimate with little hard data behind it, and that babies vary a lot. In one study it cites, babies learned to move food to the back of the mouth to swallow at an average of about 5 months, with a range from 2 to 7½ months.

The American Speech-Language-Hearing Association (ASHA) describes the same change from the other side: at 4 to 6 months, babies start to open their mouth for a spoon and use their tongue to move food to the back of the mouth to swallow. By 6 to 9 months, they move food around the mouth with their tongue.

How it fits with readiness for solids

Losing the tongue-thrust reflex is one of the signs your baby is ready for solid food. The AAP lists it by name, and the CDC and NHS describe the same thing: your baby swallows food instead of pushing it back out onto their chin.

It’s one sign, not the whole picture. Look for these signs together, not just one of them:

• Sits up alone or with support, like in a high chair
• Holds their head steady and controls their neck
• Brings things to their mouth, and tries to grab small objects like toys or food
• Swallows food instead of pushing it back out onto their chin

Most babies are ready at about 6 months, the age the CDC, AAP and NHS recommend for starting solids. Starting before 4 months is not recommended. A fading reflex alone at 4 months doesn’t mean your baby is ready. See is my baby ready for solids?

You can only see the swallowing sign once food is offered. If your baby shows the other signs at around 6 months, watch for it on the first spoonfuls.

Reflex, or just learning?

Some food coming back out in the first weeks is normal, even after the reflex has gone. The AAP explains that if food dribbles back out onto the chin, your baby may not yet be able to move it to the back of the mouth to swallow. That’s normal: they’ve never had anything thicker than breast milk or formula.

The AAP suggests:

• thinning the food for the first few tries, then thickening it gradually
• or waiting a week or two and trying again

A few other things can look like tongue thrust:

• Gagging. A baby who gags may push their tongue forward or out of their mouth, have watery eyes, or retch to bring food forward (NHS). It’s noisy and normal while they learn. See gagging vs. choking.
• Not liking it yet. It can take 10 tries or more for a baby to accept a new food or texture (NHS). See spitting out food.
• Not hungry, or too tired. Pick a time when your baby isn’t tired, and stop when they close their mouth or turn away (NHS).

If it seems to persist

• Under about 6 months: wait. Keep to breast milk or formula, and try again in a week or two. There’s no need to rush.
• Around 6 months: if most food still comes straight back out, thin it for the first few tries, or wait a week or two and try again (AAP). Keep offering, at your baby’s pace.
• Past about 6 months, if it keeps happening: if your baby still pushes most food out after a week or two of trying, or other readiness signs are missing, talk to your pediatrician, GP or health visitor. Most babies show the signs together at about 6 months (CDC, AAP, NHS), but babies vary, so a check is a sensible next step rather than a sign that something is wrong.

Talk to your doctor sooner if your baby often coughs or chokes during meals, has trouble with milk feeds, or isn’t gaining weight as expected. ASHA says not to wait to get help if your child is having trouble breastfeeding, bottle feeding or eating solid foods.

A tongue that can’t move freely is one thing a doctor may check. See tongue tie and feeding. A speech-language pathologist (speech and language therapist in the UK) can assess how your baby uses their mouth and tongue: see when to see a feeding therapist.

Tongue thrusting in older children

“Tongue thrust” is also used for something different in older children: a habit of pushing the tongue forward when talking, eating or drinking. ASHA describes it as a common type of orofacial myofunctional disorder, which can affect speech sounds, chewing and swallowing, or the teeth. It’s assessed by a dentist or orthodontist, a doctor, and a speech-language pathologist. It isn’t the same as the baby reflex in this guide.

Choking: what to do

Gagging is noisy. Choking is quiet: your baby can’t cough, cry or breathe properly. Stay with your baby whenever they eat (NHS).

If your baby can’t breathe, cough or cry, they may be choking: start choking first aid straight away. Shout for help and have someone call 911 straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once. Don’t leave your child to find a phone.Shout for help and start back blows and thrusts straight away. If someone is with you, ask them to call 999 now. If you’re alone, call 999 (on speaker) if the blockage hasn’t cleared after one round of back blows and thrusts, and keep going until help arrives.Shout for help and have someone call your local emergency number (such as 112 in Europe or 000 in Australia) straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once.

Even if the object comes out, get medical help (NHS).

Where US and UK advice differs

• The signs. The NHS gives 3 signs that appear together from around 6 months: sitting and holding the head steady, coordinating eyes, hands and mouth to pick up food, and swallowing food rather than spitting it out. The CDC and AAP list more signs, including opening the mouth when food comes near and moving food from the front to the back of the tongue.
• The age. Both recommend starting at about 6 months. US advice (CDC, AAP) adds that starting before 4 months is not recommended. The NHS says to wait until around 6 months, and to ask your health visitor or GP for advice if your baby was born prematurely.