What is a tongue-tie and how can it impact my child’s speech?

Tongue-tie (medically known as ankyloglossia) occurs when the lingual frenulum – the membrane beneath the tongue which attaches the tongue to the mouth base – is too large and restricts tongue movement. This anatomical change restricts the tongue from reaching certain points in the mouth, often necessary for producing certain speech sounds. A tongue that lacks a full range of motion may fall short of the target placement required to make certain speech sounds, causing an articulation disorder. Tongue-tie may also impact feeding and oral hygiene.

Doctors typically recommend Lingual frenectomies when infants exhibit difficulty latching or suckling during nursing. In older children, their tongue may protrude out when drinking from a cup or eating from a utensil, increasing the chance of choking and resulting in messy eating.

Visually, the tongue may appear fattened due to the inability to completely extend to its full length without great effort. In more severe cases, it may appear heart-shaped with a cleft in the center from being pulled back.

How does a tongue-tie impact speech?

Because many speech sounds require the lifting or retraction of the tongue to produce, there is evidence that in many cases, a tongue-tie may contribute to speech sound errors. Sometimes, sounds impacted are “l” and “r .” In other instances, tongue-tie may contribute to a lisp. For example, since the production of “s” and “z” requires the tongue tip to lift up to the alveolar ridge, they may not be able to be produced if the tongue is anchored down.

To compensate for this inability, the jaw and tongue body is often thrust forward, causing the tongue tip to emerge between the teeth in a lisp. As a result, single words, phrases, or short sentences may be produced without errors. Still, the demands made on the tongue during conversation (i.e., fast rate and a variety of surrounding speech sounds requiring complex movements) become too great for the anchored tongue, resulting in disordered speech.

Why should my child get a frenectomy?

Scheduling a lingual frenectomy to correct tongue-tie is recommended for those with resulting speech and feeding issues as these issues will likely persist without treatment. While children with untreated tongue-tie can improve their speech through skilled therapy, progress may be slow or limited by the anatomical restriction. While many parents are concerned about their child’s short-term discomfort, surgery is fast – often performed with a laser by a pediatric dentist – and the incision heals quickly.

After a lingual frenectomy has been completed, the tongue is typically still weak from being anchored down, so skilled speech therapy is still needed in most cases. The degree of success in speech outcomes following a frenectomy will also be affected by individual factors such as the size of the oral cavity and the tongue’s posture. The child’s age also plays a significant role; Children typically undergo frenectomies before the age of 3. Speech outcomes are best when frenectomies occur at this young age because children over the age of 3 have passed the age of orofacial development. As a result, more skilled therapy will still be necessary to instruct jaw and tongue positioning after age 3.

Research has long shown a correlation between tongue-tie and articulation disorders. Increasing the tongue’s range of motion allows for less effortful lingual placement during speech. In light of this science, the long-term benefits of a lingual frenectomy on articulation far outweigh short-term discomfort.

If your child is experiencing speech sound distortions and has a tongue-tie, to maximize speech therapy outcomes, talk with your ENT or pediatric dentist about scheduling a lingual frenectomy as soon as possible. It may be critical for your child’s success in speech.

Kat Winger, M.S. CCC-SLP

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