Should I get my child’s tongue tie clipped?

I’m a speech and language pathologist, and a mom of 3.  When my youngest son Miles wasn’t meeting speech milestones, we started to explore contributing factors. It turns out he had a tongue tie and a lip tie! This topic hits close to home as a mom AND a speech therapist, and I want to share my experiences with you.

My personal experience as a parent:

My 17-month-old, Miles,  had not been making any ‘t’ or ‘d’ sounds and I never saw his tongue lift up. I had a speech therapist friend come evaluate Miles and see what she thought.  she recommended I take him to a pediatric dental specialist to get him evaluated for a tongue tie, also known as Ankyloglossia. Despite having already been evaluated for a tongue tie at his pediatrician’s office and never having problems with feeding or sleeping, I decided it wouldn’t hurt to get a second opinion. Before doing so, I had his 18-month checkup at the pediatrician’s office, where I had the pediatrician check him for Ankyloglossia again. Yet again, she did not find a tongue tie.

For the second opinion, my friend referred me to Dr. Kirk Kollmann at Dentistry for Kids. He was amazing! He was very gentle, well spoken, and knowledgeable. He examined Miles and sure enough he had a class 2-3 anterior posterior tongue tie and he also had a lip tie. I trusted Dr. Kollman’s expertise in this area and agreed with his assessment of Miles.  Kids Dentistry was great and said they could perform the frenectomy (tongue tie release procedure) on the same day.

What did the frenectomy procedure look like?

They wrapped Miles up in a swaddle, gave him some local anesthetic, and used a laser to clip his tongue and lip ties. The team was sweet and nurturing and took good care of him. He was given back to me a few minutes later, he hugged me tight, and then returned to his normal self almost instantly. We were able to run errands afterwards and he only needed Ibuprofen for discomfort for a few days. I performed some oral exercises on the area that was clipped a few times a day to keep everything moving and we went back a week later to get it re-checked. 

What were the results from the frenectomy?

Miles’ developed increased range of motion of his tongue immediately. He now has more range of motion and coordination of his tongue. He is able to elevate his tongue and make consonants that originate at the alveolar ridge, the space right behind the two front teeth, like d,t,and n.  I’m not quite sure how much the tongue tie set him back in his speech development. He never displayed any symptoms of the tongue tie except for the inability to make certain sounds and the inability to lift his tongue from the floor of his mouth, which was hard to notice in such a young child. I hope he continues to increase his ability to make sounds and gain tongue strength and coordination in the future.  

What exactly is a tongue tie or Lip Tie (restrictive frenum)?

 A frenulum, a small frenum, is a narrow fold of mucous membrane connecting a moveable part to a fixed part. The lingual frenulum is generally under the mid-portion of the tongue. It can help to stabilize the base of the tongue. With Ankyloglossia, the lingual frenulum has an anterior or posterior attachment. This causes adhesion of the tongue tip to the floor of the mouth and can result in restricted tongue movement. 

What are signs and symptoms of Ankyloglossia (a tongue tie)?

The diagnostic characteristics of ankyloglossia are not always easy to detect. Every person with a tongue tie is different. Some signs and symptoms may include:

    • Inability to stick the tongue out far. 
    • Because the tongue is tied down it becomes notched at the midline and can result in a heart-shaped edge. 
    • The patient may be unable to touch the roof of the mouth with the tongue tip when the mouth is open.  
    • Excessive wetness or drool in the oral cavity or mouth.  
    • Attachment of tongue onto the tongue floor and/or floor of the mouth.
    • A family history of Ankyloglossia.
    • Speech imprecision, they may have a lisp.
    • Orthodontic concerns.
    • Mouth breathing.
    • They patient may have an interdental swallow, swallowing with the tongue in-between the teeth.
    • While eating food may be scattered due to reduced range of motion and coordination of the tongue.

How does a tongue tie negatively effect my child?

    • A tongue tie can cause feeding problems and difficulty with breastfeeding: Newborns with Ankyloglossia may have trouble latching onto a nipple for sucking but the majority have no early feeding problems. As a child gets older Ankyloglossia can cause difficulty with food control and clearing solids out of the mouth. 
    • A tongue tie can cause speech challenges:Ankyloglossia can cause speech deficits in articulation. If the movement of the tongue is restricted children may not be able to make all speech sounds and this can result in an articulation or phonological disorder. 
    • A tongue tie can cause dental problems:Since the tongue has restricted range of motion, one may not be able to use the tongue to clean food off the teeth or gums and this could lead to increased cavities and tooth decay.

How does a tongue tie (Ankyloglossia) effect Speech?

A tongue tie may or may not be the cause of speech challenges. If the tongue is being tied down, then the speech difficulties may certainly be caused by this. If the movement of the tongue is restricted children may not be able to make all speech sounds and this can result in an articulation or phonological disorder. 

What speech issues may occur that are related to a tongue tie?

    • Connected speech and rapid, loud, and whispered utterances.
    • Phrasing
    • Voice quality
    • Sentence length in spontaneous speech
    • Consistency under different conditions of speed volume prolonged utterance
    • Challenges with the following sounds: L, s, z,th, n,  t,  d,  r 
    • A lisp

My own experience with Ankyloglossia

I had Ankyloglossia. I did not have a frenectomy until 7th grade. It did not affect anything! I could speak just fine. I could not stick out my tongue very far and my girlfriends teased me and said I would never be able to French kiss. My dentist was the one who finally recommended I got it clipped. I remember going to see a dental specialist, had some local anesthetic, and it was done. I ate ice cream afterward and felt fine Now, I have full range of motion of my tongue.

What did I learn from this experience?

I learned to always seek a second opinion from someone that specializes in tongue ties. The people who specialize in diagnosing tongue ties are dentists, Ear Nose and Throat doctors (ENTs), Oral Facial Myologists, and some speech and language pathologists.

Should you get your child’s tongue clipped?

 YES! Get the frenectomy, get it clipped.

It is a simple outpatient procedure; babies require no anesthetic. Without a frenectomy, many problems and symptoms may occur. These symptoms and problems are life lasting and can be avoided. Maximize your child’s potential by releasing their tongue. 

What is a Lip Tie?

Upper lip-ties refer to the band of tissue, frenum, that attaches the upper lip to the maxillary gingival tissue (upper gums) at midline. Although most babies should have a frenum that attaches to some degree to the maxillary arch, the degree of restriction varies

What problems does a lip tie cause?

Challenges with breastfeeding and bottle feeding: It can cause an inadequate latch on a mother’s nipple. This can lead to fussiness, a callus on the baby’s upper lip, and painful nursing. 

    • It can cause bottle feeding challenges: Inadequateseal on the bottle nipple.
    • Breastfeeding andbottle feeding a baby with a lip tie can cause other symptoms to occur:
      • Gassiness or fussiness.
      • Treatment for gastroesophageal reflux disease.
      • Fatigue resulting in falling asleep at the breast
      • Discomfort for both baby and mother, resulting in shorter feedings
      • Need for more frequent feedings.
      • Poor coordination of suck, swallow, breathe patterns.
      • Inability to take a pacifier.
    • Lip ties can also cause increase difficulty with spoon feeding, finger feeding, and oral hygiene and dental issues.

 

References:

  1. Ankyloglossia: To Clip or Not to Clip? That’s the Question. The Asha Leader. December 01.2005.Volume 10.https://leader.pubs.asha.org/article.aspx?articleid=2278327)
  2. Holtzman, Sandra, MS, CCC-SLP. (Northern Speech Services.)Tongue Tie 101 For SLPs: What Is Our Role?

3. Just Flip the Lip! The Upper Lip Tie and Feeding Challenges. (ASHA Leader.)March 10, 2015. Potock, Melanie MA. https://blog.asha.org/2015/03/10/just-flip-the-lip-the-upper-lip-tie-and-feeding-challenges