Tongue tie, also known as ankyloglossia, is a condition in which the bottom of the tongue is tethered to the floor of the mouth. The connecting band of tissue, called a lingual frenulum, is sometimes so strong that the condition may ultimately interfere with feeding, speech, and hygiene. 

Tongue tie is relatively common. In some cases, parents can opt for surgical treatments that remove the connective tissue. However, others may feel more comfortable with a wait-and-see approach before scheduling treatment. 

You should consult with your child’s pediatrician and with a speech language pathologist to determine if your infant’s tongue tie may cause problems down the road. It is very difficult to know how the limited lingual movement will impact skills in the future. Professionals are often making their “best guess” and relying on past experiences. 

What is Tongue Tie?

The cause of tongue tie is, essentially, a lack of separation between the tongue and the bottom of the mouth. When an infant is in the embryo stages, these areas of the mouth are fused. As the embryo grows, the tongue and the bottom of the mouth differentiate. Tongue tie occurs when this differentiation process is left incomplete.

When the tongue is not sufficiently separated from the floor of the mouth, several common activities can become challenging for infants and children:

  • Feeding can sometimes be more challenging for infants, as the tongue can be limited to its ability to latch onto the breast or bottle.
  • Children attempt to compensate for limited lingual range of motion so they create compensatory behaviors creating tongue movements that do not enhance feeding skills or speech sound productions
  • Food can get caught beneath the tongue, leading to poor oral hygiene.
  • Difficulty making some common speech sounds, such as “l,” “r,” “th,” “d,” “z,” “s,” “n”, and “t.”

Treatment for tongue tie can take several different forms. In some cases, a simple surgical procedure can sever the tissue tethering the tongue to the floor of the mouth. A surgeon will then provide the child with exercises that are designed to develop muscle movement and build kinesthetic awareness. However, surgery is not always necessary or advised.

Speech Therapy for Tongue Tie

The surgical procedure that severs the connective lingual frenulum is called a frenulectomy (or frenuplasty for more substantial tissue removal).

These two surgical procedures were once common ways to treat tongue tie, but both have waned in popularity over the years. In fact, there’s much debate in the medical community regarding the utility of surgery, so the decision will often come down to a family’s specific needs and the recommendation of their pediatrician.

Whether parents opt for surgery or not, children will likely benefit from speech therapy. For kids who have undergone a surgical “tongue clipping” procedure, a speech therapist will:

  • Help develop new muscle movements that can help with enunciation.
  • Improve awareness of the total range of motion that the tongue can present. Your child may have become quite accustomed to a limited range of motion.
  • Address other speech delay issues that may have been inaccurately attributed to your child’s tongue tie.

Likewise, kids who have not undergone surgical correction may find speech therapy provides an essential avenue to develop vital speaking skills. For these children, a speech pathologist will:

  • Work with your child to address speech delays that might be associated with tongue tie.
  • Develop alternative tongue positions that your child may not have discovered on their own.
  • Address other speech delay issues that may be inaccurately attributed to your child’s tongue tie.

Does Tongue Tie Always Require Speech Therapy?

While it’s true that the lingual frenulum may limit tongue mobility, some children may find other ways to compensate for limited tongue movement during speech. These alternative tongue positions may be just as effective as traditional tongue placements; however, the distortion in movement may impact other phonemes.

In this way, children may develop alternative ways to pronounce “d” or “t” sounds, for example. However, the sounds that may become most challenging for children with tongue tie are the “th”, “r”,  and “l” sounds, largely because it’s challenging for children to find alternative tongue positions that are effective with those sounds.

This is why evaluation is such an important step. Your child’s speech language pathologist will be able to examine which speech sounds your kiddo is pronouncing effectively and which might need a little extra work. 

Making Decisions About Tongue Tie and Speech

Tongue tie isn’t common, but it’s not exactly rare either. Somewhere between 0.2 and 2% of infants are born with lingual frenulums that are considered abnormally tight or that restrict movement. It’s also important to note that not all cases of tongue tie are equally severe, and it might be challenging to forecast just how much your child’s case may interfere with their daily lives as they grow.

That’s why decisions about tongue tie are not always cut and dry. There are varying degrees of treatment options from minor clipping of the lingual frenulum to more substantial removal of tissue. Most parents will make a decision about treatment possibilities in consultation with a pediatric surgeon and speech language pathologist.

If you have questions about what to expect if your child has tongue tie, a speech language pathologist will be able to tell you how the condition may impact certain speech capabilities. A speech language pathologist will also be able to recommend therapy options both before and after possible surgical treatment.

With the right approach, your child can enjoy meaningful communication and you can make informed decisions about your child’s tongue tie. Please contact us to learn more or schedule an appointment.