Understanding Tongue Tie: A Speech Pathologist’s Perspective

What is Tongue Tie?

As a pediatric speech pathologist, one topic parents frequently ask me about is tongue tie. Tongue tie is a condition where the band of tissue under the tongue, which connects the floor of the mouth to the tongue, is constricted. This can impact the tongue’s movement during speech and feeding. It can also impact the tongue’s resting position, creating less optimal breathing patterns, and can result in other oral-motor difficulties such as open mouth posture and difficulty sleeping.

The Tongue Tie Controversy

The controversy surrounding tongue tie primarily revolves around the surgical procedure that releases or cuts the tongue tie, also called a frenectomy. In this procedure, the tongue tie is released using a laser and is usually performed by an Ear Nose and Throat (ENT) doctor or related healthcare provider. The goal of a tongue tie release procedure is to allow a greater movement for the tongue to help the child with optimal speaking, eating, breathing, and sleeping. The procedure is done in conjunction with therapeutic intervention to promote functional oral-motor patterns and oral-motor placement for the child.

However, recent controversy around this procedure has raised questions about its necessity. The New York Times recently released an article outlining this controversy and interviewed parents who shared their stories, criticisms, and regrets after seeking out a tongue tie release procedure.

On the other hand, other parents anecdotally have shared with providers and on social media about how the tongue tie release was instrumental in allowing their child to access functional speech, feeding, sleep, and optimal breathing.

Current research in the literature about the tongue tie release has shown that the tongue tie procedure has helped certain children in certain areas of oral-motor development, such as breathing patterns during sleep or sleep apnea (Camacho et al., 2017), (Huang et al., 2015) as well as some infants who are demonstrating a tongue tie and are having trouble with breastfeeding or nursing (Caloway et al., 2019).

There is conflicting results about whether or not the procedure helps young children with improved speech and articulation (Ariestiana et al., 2024), (Messner et al., 2020).

Conflicting information and perspectives on tongue tie release can leave some parents feeling confused and concerned about how to choose the best way forward to address their child’s speech, feeding, and oral-motor difficulties.

My thoughts

1.     A Thorough Evaluation by an Experienced Speech Pathologist is Key

If you are a parent having concerns about your child’s oral-motor development, a formal evaluation by a licensed Speech-Language Pathologist is the first step. Every child is different so a detailed evaluation of their speech, feeding, and oral-motor patterns is needed before choosing the best path forward. It is also important to find a Speech Pathologist who specializes in oral-motor development and has additional training on top of their licensure, such as Oral-Placement Therapy training.

A formal evaluation will help identify any possible underlying causes, less optimal oral-motor patterns, as well as any challenges with placement, coordination, muscle tone or strength of the jaw, lips, tongue, or cheeks. All of these muscles need to have adequate strength and coordinate together for speech and feeding. A good Speech Pathologist will listen to your concern as a parent and work with you to evaluate your child then develop an individualized speech and feeding plan.

2.       Less Invasive Route First  

 For healthcare providers, it is often considered best practice to try the least invasive route first. In the case of a suspected tongue tie, the Speech Pathologist has the option to try non-invasive techniques and strategies before referring for a more invasive approach, such as tongue tie release procedure.

My practice sees children ages 1-5 years old so while I cannot speak to infant nursing and tongue tie release, I do regularly see young children who struggle with speech production and feeding. In these cases, my first step is often implementing oral-motor techniques and targeted exercises that help children with accurate placement and movement of the tongue, lips, and jaw to address their speech and feeding challenges. In some cases, addressing these motor challenges in a structured, targeted way improves function and helps us achieve the desired oral-motor pattern for functional speech and feeding.

3.     In Certain Cases, A Referral May Be Warranted

A young child’s oral-motor difficulties may be resolved by therapeutic interventions, home practice, and support from a Speech-Language Pathologist. However, in certain cases, there may be an anatomical issue where the tongue is truly constricting movement and placement, resulting in challenges with speech and feeding. This may also create less optimal breathing and sleep patterns. In the cases where therapeutic interventions alone may not be enough, a professional referral to an ENT or related professional to consult about tongue tie release may be warranted. Pre-op and post-op therapeutic exercises are also necessary should a tongue tie release be recommended by the doctor.

It is also important to know that Speech Pathologists look at other issues outside of tongue tie that impact speech development and may warrant a referral, such as enlarged tonsils enlarged adenoids, hearing loss concerns, and more.  

What to consider in Speech Therapy

A holistic approach is key. A Speech Pathologist’s job is to look at the whole picture when it comes to a young child struggling with speech and feeding. This includes strategies to address muscle tone, oral habits, oral-motor patterns, and motor skills. In some cases, it may include a professional referral for underlying anatomical issues including, but not limited to, tongue tie.

More recently, a spotlight has been put on the tongue tie release. However, there are many factors for parents and Speech Pathologists to consider and understand when addressing the cause of speech and feeding difficulties. This holistic approach needs to be kept in mind when assessing a child and choosing the best path forward to address their challenges.

Please note the above is not meant to be taken as medical advice. You should always consult with a licensed healthcare provider such as your pediatrician, Speech-Language Pathologist, Ear Nose Throat doctor (ENT), or other related licensed healthcare provider if you are having concerns about your child’s development. 

References:

Ariestiana, Y. Y., Gazali, M., & Basyar, H. (2024). Effectiveness of Frenuloplasty in Ankyloglossia on Speech Quality: A Systematic Review. Open Access Macedonian Journal of Medical Sciences, 12(1), 12–21. https://doi.org/10.3889/oamjms.2024.960

Caloway C, Hersh CJ, Baars R, Sally S., Diercks, G., Hartnick CJ. (2019). Association of feeding evaluation with frenectomy in infants with breastfeeding difficulties. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2019.1696

Camacho, M., Noller, M. W., Zaghi, S., Reckley, L. K., Fernandez-Salvador, C., Ho, E. Dunn, B., & Chan, D. (2017). Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology: And Head & Neck, 274(8), 2981–2990. https://doi.org/10.1007/s00405-017-4545-4

Huang, Y.,Quo, S., Berkowski, J.A. & Guilleminault, C.S. (2015). Short lingual frenulum and obstructive sleep apnea in children International Journal of Pediatric Research, 1:1, ISSN:2469- 5769.

Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg. 2020 May;162(5):597-611. doi: 10.1177/0194599820915457. Epub 2020 Apr 14. PMID: 32283998.