Ask! Struggling with sippy cup

Q. I've noticed that my daughter sticks her tongue way out when she's drinking from her sippy cup. It looks really sloppy. Is this ok?

A. Kids protrude their tongue (stick it out) for many different reasons. If a child has low muscle tone in the jaw, cheeks, tongue or body, she may use tongue protrusion to stabilize the sippy cup so that she can drink from it. Children with upper respiratory problems often protrude their tongue to open the airway, making it easier to breathe. These children often develop mouth breathing and an open-mouth anterior tongue rest position.

The tongue protrusion you describe under the sippy cup could be the result of an open-mouth anterior tongue rest position. Look at your daughter when she is playing, having quiet time, or sleeping. If you see that her mouth is open and her tongue is protruded to or past her lips, she may have an open-mouth anterior tongue rest position.

An open-mouth anterior tongue rest position can interfere with feeding development and speech articulation (the correct formation of speech sounds). Feeding complications can include difficulty swallowing, choking, gagging, food refusals (especially foods that require mature chewing patterns such as meats, vegetables and fruits), swallowing foods whole and food pocketing.

If your child's tongue protrudes and she is unable to elevate it during speech (or has difficulty doing so), she may have difficulty producing clear speech sounds, especially th, l, and s.

From your description, it sounds like your daughter is protruding her tongue too far under the sippy cup. The first thing you should do eliminate the sippy cup, as sippy cups encourage tongue protrusion. Bottles, pacifiers or thumb sucking must also be eliminated. Help your daughter transition to a straw (not a straw cup) with correct straw placement or to an open cup.

Children with tongue protrusion often do have difficulty with speech and feeding, so I also recommend seeking the advice of a speech and language pathologist as soon as possible. Oral motor programs can strengthen oral musculature and reduce any feeding or speech complications.