Q: I use your “butterfly position” on many school age kids and most of them are able to understand it and follow directions. However, many of the preschoolers have a hard time understanding “biting the sides of their tongues.” Do you have a different way of approaching preschoolers when you want to stabilize the back of their tongues?

I also have found that many preschoolers have a hard time understanding how to make the butterfly position. And children with lower cognitive skills have difficulty, too. And some regular old clients have difficulty, too. So I have things I teach them to do at home, and I have other things I do in therapy.

At Home

I give them a series of things to do everyday after they brush their teeth while looking in the mirror. I teach them to brush, spit, rinse, and then:

1. I teach them to bite firmly at the molars, smile broadly to show all the teeth, and hold this position while counting to ten (or five, or three…). This gets them to pull the jaw up and back, and the lips back and lateral, into firm positions. These movements will influence the tongue to pull up, back, and laterally. This is because of the process known as an Associated Reaction – moving one body part influences the movement of closely associated body parts. As such, strong upward, backward, and lateral movement of the jaw and lips influences the tongue to do the same.
2. I teach them next to take their toothbrush and brush forward-and-back along the midline of the tongue, up and back three times in a row. This stimulates the Tongue Bowl Reflex (TBR), which causes the tongue to flatten, flair, and elevate the lateral margins.
3. I teach them to take their toothbrush and brush each lateral margins forward-and-back three times. This stimulates the muscles there and influences them to increase tone. It also gives them a very clear idea of where the back sides of the tongue are.
4. I teach them to actively spread the sides of the tongue laterally by teaching them how to grab the tongue and pinch it medially: Placing the thumb on one side, and the index finger on the other side, on the back 1/3 of the tongue. Then squeeze the finger and thumb together to pinch or squeeze the tongue body toward midline. Then use the tongue muscles to force both sides of the tongue toward both sides at the same time. (I suggest you do it to yourself a few times so you know what it should feel like. Then learn to do it with the clients. Make sure to follow sanitary procedures.) This one also can be hard for a preschool child to grasp. That depends upon cognitive level. But if they can do it, it is a fantastic tool! This above all else teaches the client to spread the back lateral margins of the tongue.

In Therapy

In therapy, I encourage all the activities described above using toothbrushes or Nuk Oral Massage tools, and I do a few more things to teach the actual Butterfly Position:

1. I teach them to bite a tongue depressor or a Nuk brush in the back at the molars on both sides, so they get the idea of biting with the molars.
2. I brush, rub, or tap the sides of the tongue with something textured like a toothbrush or a Nuk. This gives them a tactile idea of the back lateral margins of the tongue.
3. Once they have the idea of biting (#1), and once they can feel the lateral margins (#2), I teach them to combine the two, and bite the back lateral margins.
4. Then, I use Resistance to teach them to elevate the sides of the tongue by pressing down against the back lateral margins with a firm tool like a tongue depressor. I teach them to push the tool upward with the back lateral margins.
5. Then I teach them to combine the idea of biting down on the sides (#3) and then pushing up (#4). Then they’ve got it.