Why does my baby keep sticking their tongue out?

Cleveland Clinic explains that healthy babies are born with a tongue-thrust reflex, also called the extrusion reflex. When something touches the lips or the front of the tongue, the tongue pushes forward. It helps protect young babies from choking while they feed from the breast or bottle, and it starts to disappear around 6 months, when babies are getting ready for solid foods.

Newborns have a set of feeding reflexes, including rooting (turning toward a touch on the cheek) and sucking. Cleveland Clinic notes that most newborn reflexes fade between 4 and 6 months, and all should be gone by the first birthday. Lots of tongue movement in the early months is part of this normal toolkit.

If your baby pushes a spoonful of food straight back out, that is often the reflex at work. HealthyChildren.org says that a baby who pushes food out so it dribbles onto the chin may not yet be able to move food to the back of the mouth to swallow. It suggests thinning the food at first, gradually thickening it, or waiting a week or two before trying again.

The AAP recommends breast milk alone for about the first 6 months, with solids introduced around 6 months. Other readiness signs include good head control, sitting with support, and showing interest in food.

A tongue that is often out is rarely a problem on its own. It is worth raising with your pediatrician when it is constant, the tongue looks large, or there are other symptoms.

• Low muscle tone. Conditions that affect the muscles used for feeding and speech, such as Down syndrome, can make the tongue rest forward. Cleveland Clinic lists Down syndrome among conditions that contribute to tongue thrust and to an enlarged-looking tongue.
• A large tongue (macroglossia). Cleveland Clinic and StatPearls describe Beckwith-Wiedemann syndrome, Down syndrome and hypothyroidism as causes in children. Signs can include a tongue that sticks out, drooling, difficulty feeding, and noisy breathing or snoring.
• Mouth breathing. A blocked nose or enlarged adenoids can push the tongue and jaw forward to help airflow.

Tongue-tie is the opposite pattern: the NHS describes babies who cannot lift or stick out the tongue well, with a heart-shaped tip and feeding problems such as trouble latching, clicking and poor weight gain.

Most children lose the tongue-thrust pattern well before school age. Cleveland Clinic says that by age 4 most children have lost it completely, and advises seeing a pediatrician or dentist if a child of 4 or older still pushes the tongue forward when swallowing or speaking, since it can affect speech and how the teeth line up. Long-term pacifier, bottle or thumb use past about age 3 can help keep the habit going.