Introduction 

Grace is a new mother, and she is scared. Her son Thomas is three years old, but he doesn't speak like most children his age. Her sister said it was autism; her mother says it's a tongue tie. 

All Grace knows is that all the information on the Internet is frightening. Grace's worries are valid, especially since speech is a fundamental way that we can connect with the world, and it relies heavily on the workings of our mouth, tongue, and vocal cords. Just like Grace, many other mothers need reassurance.

 Let’s dive into what a tongue tie is, how it affects speech, and what can be done to help. 

So, what is a tongue tie?

This is a condition that limits the function of your baby’s tongue, and while some babies have difficulty latching on for breastfeeding or taking in enough milk, others may experience difficulty in speech.² According to the American Academy of Paediatrics, anywhere from 1% to 11% of newborns have signs of a tongue tie, but the condition appears to be more common in babies assigned male at birth (AMAB). 

While sometimes tongue-tie may not cause problems, some cases may require a simple surgical procedure as a correction to help their tongues move better. 

What is tongue tie?

Tongue-tie, or in medical jargon, ankyloglossia, is a condition that is present at birth that restricts the tongue's range of motion. The band of tissue (lingual frenulum) that connects the bottom of the tongue's tip to the floor of the mouth is unusually short, thick, or tight. 

Depending on how much the tissue restricts tongue movement, it may interfere with breastfeeding and even speech. 

How tongue tie affects speech 

While your child's tongue is primarily a digestive organ that moves food around the mouth to help them chew and swallow, it also helps keep their airway open so they can breathe properly. It is also very vital in speech; the tongue helps you make different sounds so you can speak and form words clearly.³

By coordinating your tongue’s movement with your lips and teeth, you’re able to produce sounds, which can be made into speech. Due to the tongue's wide range of mobility and innate skill to make complex movements in relation to other parts of your mouth, over ninety words per minute can be produced.

The mobility of the tongue and range of motion directly affect the child's speech, especially since specific movements with your tongue create different types of sounds that can, in turn, produce speech.

For example, pronouncing the letter “K” involves narrowing your tongue in the back of your mouth, and producing the letter “S” involves using the tip of your tongue as it moves backwards. Pronouncing consonants or rolling the letter “R” is dependent on specific movements of your tongue.

If your child has a tongue tie, their ability to move their tongue and properly make these sounds may be affected; they may still be able to pronounce these sounds, but they may be different. 

• A few of the common sounds that children with a tongue tie may struggle with include:
  • "T," "D," "L," and "R" sounds, which involve the tongue touching the roof of the mouth
  • "S" and "Z" sounds 
  • "Th" sounds, where the tongue has to extend between the teeth

Now, while not all children with tongue ties may have speech issues, these signs might give you a clue as to whether you should see a doctor.

Recognising tongue tie 

While seeing your child with a tongue tie might be scary, you should not have to panic; here are some common signs parents might notice: 

• Difficulty lifting the tongue to the upper teeth or in moving their tongue from side to side⁵
• Trouble sticking out the tongue past the lower front teeth. A tongue that appears notched or heart-shaped when stuck out.
• Difficulty latching onto the breast deeply. In cases like this, your baby doesn’t latch on or cries when trying to latch, makes clicking sounds, or pops off the breast
• Difficulty or frustration while making sounds. When you have identified any of these signs, or even if you didn't identify them but are still worried about your baby, your next step should be seeking professional help

Early identification of a tongue tie by a professional is important and cannot be overemphasised. Once the professional has confirmed it, a plan for management can now begin that will improve life for you and your child.

How is ankyloglossia diagnosed?

Paediatricians typically diagnose tongue-tie soon after a baby is born, working hand in hand with lactation consultants, so they can identify if there might be other variations in a baby’s tongue anatomy that may cause speech difficulty. Just because your child has a frenulum that’s tighter or shorter than usual doesn’t mean they have tongue-tie or need treatment. 

So your healthcare providers will take good care to examine before giving a diagnosis. To determine if your baby has tongue-tie, your providers will:

• Ask about your breastfeeding history. This will definitely include any breastfeeding experiences with other children. If your baby has tongue-tie, you might have noticed that the latch feels different compared with other babies you’ve breastfed.
• Your providers will also ask how often you breastfeed, how long each session lasts, and whether you pump and/or supplement with formula.
• Review your baby’s medical history, as there are many different factors that can affect your baby’s ability to breastfeed. These include neurological disorders, heart conditions, and blockages in their nose or airways.
• Give your baby a physical exam. As part of this exam, a paediatrician will closely examine your baby’s tongue and all areas of their mouth. They’ll look for signs of tongue-tie or other medical conditions.

Treat or forget about it 

Once your baby has been diagnosed by a professional, it is time to look at what you can do, and the options vary; treatment for tongue-tie is controversial.

Some doctors and lactation consultants recommend correcting it right away, even before a newborn is discharged from the hospital. Others prefer to take a wait-and-see approach. That thick band of tissues may loosen over time, resolving tongue-tie, but in other cases, the tongue-tie could persist without causing problems.

In cases where surgical treatment of tongue-tie may be needed as the tongue-tie causes problems. Surgical procedures like frenotomy and frenuloplasty are available.

Frenotomy

It is a simple surgical procedure that can be done with or without anaesthesia in the hospital nursery or doctor's office. The doctor will examine the lingual frenulum and then use sterile scissors or cautery to cut the frenulum free. It is a quick procedure, and discomfort is minimal since there are few nerve endings or blood vessels in that area. If any bleeding does happen, it's likely to be only a drop or two of blood, and the child can go about their other activities. 

While complications of this procedure are rare, they may include bleeding or infection or damage to the tongue or salivary glands. As well as scarring or reattaching of the lingual frenulum to the base of the tongue.

Frenuloplasty

Is a more extensive procedure that might be recommended if additional repair is needed or the frenulum is too thick for a frenotomy. It is usually done under general anaesthesia with surgical tools. After the lingual frenulum is released, the wound is usually closed with sutures that dissolve on their own as the tongue heals.

Speech Therapy 

Speech therapists are uniquely suited to help your child with tongue tie. These therapists will ask questions about your child’s symptoms—whether they snore, are a picky eater, breathe through their mouth, drool, or have issues with articulation. If they suspect a tongue tie, they are likely to refer you to an ENT or pediatric dentist to confirm the diagnosis. Once the diagnosis is confirmed, your child may need surgical intervention.

Speech therapists can help your child navigate tongue tie before and after any surgery. Before the surgery, your child’s speech therapist will work with them to improve the range of motion of their tongue; this is referred to as myofunctional tongue exercises. This will help your child in managing their symptoms and living with tongue tie.

They will also help your child with the sounds they have the most trouble making, teaching them techniques to help their tongue move more freely and eventually rest on the roof of their mouth to be able to breathe through their nose. Your speech therapist can also teach you and your child wound recovery exercises, which are important to make sure the incision heals properly and reduces the risk of reattachment of the frenulum.

Once the surgery has been done, the speech therapist will be responsible for checking how your child’s tongue is resting on their palate and making sure it's correctly positioned and they are able to breathe through their nose. They can also address any lingering speech issues that may be there after the surgery. 

Conclusion 

While tongue tie may seem like a small physical difference, its impact on speech development can be significant for some children. Early detection and intervention are key to helping kids overcome these challenges and express themselves with confidence. If your child is struggling with speech or showing signs of tongue tie, don’t hesitate to reach out to a healthcare professional.