Parenting: Babies
Does Tongue-tie Affect Speech?
Ankyloglossia, or tongue-tie, is a condition where movement of the tongue is restricted due to a small piece of skin under the tongue called the lingual frenulum. In severe cases, the skin could be attached all the way to the tip of the baby’s tongue. The condition, which affects approximately four out of every 1,000 births, can affect breastfeeding success and may cause speech problems down the road.
At 6 weeks, Chamberlain’s pediatrician did a simple clipping of Noah’s tongue to help loosen it, and the clicking stopped. "Everyone thought the problem was solved," she says. "We have not mentioned [it] since then because we have just recently noticed it might still be a problem. His speech is not progressing the way that I believe it should."
Tongue-tie and Speech The Department of Otolaryngology at Columbia University in New York suggests the following characteristics are common in children with speech problems:
All these problems can be caused by tongue-tie. "A tongue-tie can affect the range and movement of the tongue to produce specific tongue tip sound," says Hudon. "Tongue tip sounds can be affected by tongue-tie, including ‘l,’ ‘r,’ ‘t,’ ‘d,’ ‘n,’ ‘th,’ ‘sh,’ ‘s’ and ‘z.’"
Parents need to watch and listen to see if their child’s speech is developing normally. Hudon says parents should also ask themselves these questions:
While she is unsure if tongue-tie has affected her son’s speech, Chamberlain has strong suspicions. "He is 18 months old and has not begun to talk," she says. "He makes noises and sounds but no real words. I noticed he recognizes the word ‘ball’ and he is saying ‘ba.’ His tongue is not reaching to the top of his mouth. … He cannot extend his tongue beyond his lower lip."
Chamberlain has consulted a speech therapist and is also considering surgery for her son. "I know that Noah is young and his speech could be normal for him at this age, tongue-tied or not," says Chamberlain. "However, he does seem to have difficultly extending his tongue [and] making certain sounds like ‘s,’ ‘l’ and ‘t’ sounds. I love my child and think he is perfect, of course, and I would not opt for surgery unless there was a possibility of a major speech problem."
Is Surgery the Answer? In fact, it is a surgery that many medcial professionals hesitate to do. "It used to be that all newborns and infants who were tongue-tied were 'clipped' or had a frenulectomy, but this is much less commonly done these days, except by more 'old school' pediatricians," says Dr. Vincent Iannelli, a board-certified pediatrician near Dallas, Texas, fellow of the American Academy of Pediatrics and associate professor of pediatrics at Southwestern Medical School. "The biggest reason is likely that many doctors just don't feel that it is necessary. And there is little research or proof to convince them otherwise."
Tongue-tie affected each of Hudon’s twins differently. "One of my boys could not protrude his tongue past his teeth, lateralize his tongue into his cheeks or elevate the tip to touch his upper teeth," she says. "Also, he was frequently gagging and vomiting on textured foods. My other son had much better range of motion of his tongue and no feeding issues."
Hudon’s doctor only recommended a frenulectomy on the first twin because he felt the second had a better range and that the tissue would eventually stretch even further.
"So, at 2 years of age, only one of my boys had a frenulectomy," she says. "They both developed excellent articulation skills without any need for therapy, and my son’s gagging problem disappeared after surgery. Today, my second son can elevate, lateralize and protrude his tongue past his lips without any problem. However, he still has that ‘v’ or heart-shaped tongue shape when he protrudes his tongue because it is still somewhat tied in my opinion. My first son (who had the surgery) can wiggle that tongue around his mouth (which he often does) without any problem."
If a parent wants the procedure done despite her doctor’s objections, Dr. Iannelli recommends seeing a pediatric surgeon, pediatric ENT or even a pediatric dentist. He says if he or she is experienced, a pediatric dentist would be as good as any other health professional in performing this procedure. "They are often called upon to evaluate and sometimes remove natal teeth (teeth that babies are born with) and so have experience with oral disorders of infancy," he says.
The decision to have the procedure or not is not cut and dry and can be a big decision for some parents. Every child is different and every situation must be assessed individually.
For Chamberlain, the decision will come down to whether her son will have a major speech problem that could cause him problems in life. "I think that children are cruel to one another and a child with a speech impediment will be singled out in school and will be teased," she says. "It is sad that we live in a society [where] this happens, but it does."
When Shannon Chamberlain’s third child, Noah, was 2 weeks old, her pediatrician mentioned that he might be tongue-tied. Chamberlain noticed a problem when her son began to make "clicking" noises during breastfeeding. "His tongue began to form a notch in the tip," says the Kalispell, Mont., mom. "He would nurse for a few moments, release, click his tongue a few times and try again. He began to act like he was not getting enough milk as well."
Mindy Hudon, a speech and language pathologist and iParenting.com expert advisor, is all too familiar with tongue-tie. "I was tongue-tied and so was my nephew and my twin boys," says Hudon. "Tongue-tie can cause speech and swallowing problems in children. Depending on how tight the cord is determines the severity for the potential speech or swallowing problems."
If a parent answers "no" to any of these questions, he should take the child to an ear, nose and throat (ENT) specialist or pediatrician for an evaluation.
"As a speech-language pathologist, I was concerned that my boys’ tongue-tie could impair their speech development so I had them both evaluated by an ear, nose and throat physician," says Hudon. She feels it’s important to have a child with tongue-tie evaluated by an ENT to determine if he is a candidate for a frenulectomy, a procedure where the tissue is clipped. Hudon notes, however, that not every child who has tongue-tie requires surgery.
The risks of a frenulectomy can include bleeding and infection. "I think that you have to also be concerned of complications if the procedure doesn't go well, like if too deep of a cut is made," says Dr. Iannelli. "The thing to consider is that this is still a surgical procedure, even though it is minor."
