Articles on adoption, foster care, & pediatrics

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Protruding Tongues

The issue of protruding tongues is a difficult one in international adoption. Everybody has a strong visceral reaction to seeing it because it is a feature of Down Syndrome. BUT - we can almost always rule out Down's based on other features in referral photos.

Another rare possibility but one that carries visual associations for people, and one that we test for routinely at birth in this country, is congenital hypothyroidism. This can cause coarse facial features, large fontanelles ("soft spot" on head), protruding tongue, low tone, constipation, lethargy, etc (many of which our kids have at first for other reasons) and is associated with cognitive delays if not promptly treated in the first months of life. This used to be called "cretinism", and may also trigger developmental concerns when seeing babies with their tongue out. We test for this routinely on arrival, and some countries (Korea) screen for it as well.

Protruding tongue can also happen with orphanage-related low oral-motor muscle tone from lack of appropriate feeding practices, not having toys to mouth and chew, and nutritional deficiencies. In general, low muscle tone can be associated with other developmental concerns, but it is a frequent finding in post-institutionalized children, and one that usually improves dramatically after adoption.

This is also not necessarily a muscle tone issue - it may be a common, benign involuntary tongue protrusion associated with concentration or excitement (a la Michael Jordan).

What our local developmental experts tell Dr. Bledsoe and I is that, without other features of Down's, protruding tongue (whether from larger tongue, lower oral-motor tone, smaller jaw, "Michael Jordan-ism", etc) is not necessarily a red flag for later mental retardation, etc. As with any tone issue, we need to follow it over time ... but it's an issue that usually improves with time.