What Is a Tongue-Tie, and Can It Affect a Child's Speech?
Alexis Irazoque, M.S., CCC-SLP
It’s widely believed that a tongue-tie can cause speech delays or disorders in children. But what does the research say? And if you think your baby might have a tongue-tie, what should you do?
Read on to learn the latest research around tongue-tie: What parents and caregivers should know about this condition, the surgical options, and how speech therapy can help.
What is a tongue-tie?
Tongue-tie, also known as ankyloglossia, refers to having a short or tight lingual frenulum. This is the band of tissue under the tongue that connects the tongue to the floor of the mouth. A short or tight frenulum can limit or restrict the movement of the tongue.
How common is tongue-tie?
Tongue-tie occurs in 2% to 10% of babies. In 2020, a panel of expert pediatric otolaryngologists from the American Academy of Otolaryngology said that more children were diagnosed with tongue-tie over the last decade than ever before. This is due to various reasons, such as:
Increased focus on the benefits of breastfeeding
More social media posts and websites related to tongue-tie
An increase in the number of medical professionals, specifically dentists, who treat tongue-tie
What causes a baby’s tongue-tie?
Tongue-tie is three times more common in males than females. It’s been noted to run in families and to be associated with certain genetic disorders. However, the exact cause of most tongue-ties is unknown.
How do you know if your baby or child has a tongue-tie?
Here are some common signs and symptoms you might see in a person with a tongue-tie:
Difficulty lifting the tongue to the upper teeth
Trouble moving the tongue side to side
Difficulty sticking the tongue out past the lower front teeth
A tongue that looks notched or heart-shaped when your child sticks it out
Difficulty chewing age-appropriate solid foods
Gagging or choking on foods
Pocketing or holding food in the cheeks
Can a tongue-tie cause problems?
Tongue-ties can contribute to many problems, including breastfeeding difficulties in newborn babies, speech articulation problems, and poor oral hygiene.
Let’s discuss some real-life examples of these potential concerns:
Breastfeeding problems: A tongue-tie may cause a baby to chew rather than suck, leading to poor nutrition and failure to thrive.
Speech difficulties: A tongue-tie can interfere with a child’s ability to make certain sounds, although this isn’t always the case.
Oral hygiene: A tongue-tie can make it hard for a child to clear food from their teeth, which can contribute to tooth decay and gingivitis.
Social concerns: Sometimes a person may feel embarrassed about their difficulty with certain everyday tasks, such as licking an ice cream cone.
How does a tongue-tie affect speech?
The overall consensus in the research is that a tongue-tie does not necessarily lead to a speech delay or disorder. There isn’t enough evidence to say that tongue-ties affect speech production or speech intelligibility (which is how easy it is to understand what your child says).
How is a tongue-tie treated?
According to the Mayo Clinic, a lingual frenulum can loosen over time, which can resolve the tongue-tie problem altogether. In other cases, a tongue-tie can persist without causing any problems.
However, if a tongue-tie is causing concern, there are a few treatment options. For example, working with a lactation consultant can help a baby breastfeed more easily. And a child with speech sound concerns would benefit from speech therapy.
There are also surgical treatment options for infants, children, and adults. The two types of tongue-tie surgeries are frenotomy and frenuloplasty.
Frenotomy
A frenotomy can be done in the hospital nursery (for infants) or in the doctor’s office (for children and adults) with or without anesthesia. In a frenotomy, the doctor uses sterile scissors to snip the lingual frenulum. It’s usually described as quick, with minimal discomfort. A newborn baby can actually breastfeed immediately following a frenotomy!
Frenuloplasty
A frenuloplasty is typically recommended if the tongue-tie requires additional treatment or if the frenulum is too thick to be snipped in a frenotomy. Doctors use general anesthesia and surgical tools for a frenuloplasty, and dissolvable stitches are needed. Tongue exercises may also be recommended to improve tongue movement and reduce the risk of scarring.
Complications from these surgeries are rare, but they may include bleeding, infection, damage to the tongue, or scarring.
With all of this information, it is important to know this: Tongue-tie revision, or surgery, is not recommended for the purpose of preventing any speech problems.
Can speech therapy help a child with a tongue-tie?
If a child with a tongue-tie does have speech problems, a speech therapist can try to help the child improve their speech sounds before any tongue-tie surgery is recommended. First, the speech therapist will complete a thorough evaluation to determine if there are other reasons for your child’s speech issue. Speech therapy will likely be recommended to see if treatment helps the child. The speech therapist will assess whether your child can make certain sounds after they’re given instruction, or if they are physically unable to do it because of a tongue-tie. If this is the case, your speech therapist may recommend following up with your pediatrician to discuss tongue-tie surgery. It’s important to know that speech therapy may still be needed after surgery to continue learning to make the sounds that were affected by a tongue-tie.
What parents and caregivers need to know about tongue-ties
If you suspect your child has a tongue-tie that is causing concern in any of the areas mentioned above, talk with your pediatrician. They can evaluate your child and make recommendations. The American Academy of Otolaryngology also recommends contacting a speech therapist for an evaluation before moving forward with any type of surgery. As you can see, tongue-ties and their impact on speech is a topic we know a lot about, although there’s still more to learn. However, again, it’s important to remember that tongue-tie surgery is not recommended in order to prevent speech problems. Parents and caregivers should always consider the overall impact of the tongue-tie on your child’s life as you consider next steps. If you have concerns, talk with a speech therapist. They are a critical part of your child’s care team and can help guide you along the way.
