Does Tongue-Tie Affect Speech Development?

While a tongue-tie can affect speech development it is not typically the cause. In this article we will examine what a tongue-tie is, how commonly it occurs, and what impact it has on speech development.

Understanding Tongue-Tie

Tongue-tie, or ankyloglossia, occurs when the frenulum (tissue on the underside of the tongue) is tethered to the floor of the mouth. The role of the frenulum is to provide stability, but if the tissue is too tight it can restrict tongue movement. Restricted movement of the tongue may impact the precision of articulation of sounds such as “l, t, d, r, s, or z.” In infants, ankyloglossia can interfere with effective feeding and swallowing, and it can be particularly challenging for breastfeeding. The picture below demonstrates ankyloglossia:

How Common is Tongue-Tie?

According to the American Academy of Pediatrics (AAP), most studies report a prevalence of 3-4% of infants, with a male predominance of almost 3:1. According to the National Institutes of Health (NIH), Ankyloglossia can be caused by genetic predisposition and is associated with an X-linked inheritance.

Impact of Tongue-Tie on Development

If the tongue is significantly restricted, it may result in difficulty with breastfeeding or bottle feeding and swallowing in infants. In older children, it may affect their ability to articulate certain sounds which may decrease their intelligibility. When children are not readily understood, it may cause them to communicate less or can result in social-emotional distress and behavioral challenges.

Signs Your Child May Have Tongue-Tie

Limited ability to protrude the tongue beyond the lower lip or to elevate the tongue to the alveolar ridge (roof of the mouth behind the front teeth) may be the sign of a tongue tie. In infancy, there may be inadequate expression of milk from the bottle or breast, difficulty swallowing, and maternal nipple pain or erosion. In older children, you may notice difficulty producing certain sounds such as /l/, /t/, or “r.” You may also notice patterns of messy eating.

Does Tongue-Tie Prevent a Child from Talking?

Tongue-tie does not prevent a child from talking, but it may distort certain sounds, making them less intelligible. While their language development will not be affected, they may be hesitant to communicate out of embarrassment or frustration. Some children may demonstrate reduced mouth or jaw opening or compensatory strategies such as avoiding certain words or resorting to use of gestural language.

At What Age Does Tongue-Tie Affect Speech?

Tongue-tie may begin to affect speech development when babies move beyond early babbling [when they may be only producing bilabials such as /p/ and /b/] and begin to produce sounds such as /t/ and /d/, which require elevation of the tongue. It is beneficial to seek an assessment by a qualified speech-language pathologist (SLP) to determine if speech errors are developmentally appropriate or impacted by tongue-tie. If speech difficulty is attributed to tongue-tie, early intervention can be key to preventing future speech difficulties.

Does Cutting a Tongue-Tie Help with Speech?

The tongue may be released by frenectomy or frenuloplasty depending on the age of the patient and type of medical provider performing the procedure. The procedure is generally considered safe and recovery is minimal. Research indicates that the procedure may be beneficial to outcomes, and that performing the procedure at an earlier age may optimize outcomes. Learn more at: Speech Outcomes of Frenectomy for Tongue-Tie Release: A Systematic Review and Meta-Analysis

Professional Assessment and Treatment

An infant or child with signs of a tongue tie should be examined by their pediatrician and referred to an otolaryngologist and SLP for assessment. Assessment should rule out any other conditions or causes of the feeding or speech problem. Initially, therapy can be provided to determine if the condition is amenable to therapy prior to pursuing surgical correction. Reach out to Verse therapy for an evaluation from the comfort of home through telepractice speech therapy.

Speech Therapy for Tongue-Tie

Therapy for tongue-tie may involve identification of functional issues with speech and/or feeding and establishing goals to improve the functionality of both. Exercises may involve producing and repeating sounds, using a mirror to look at tongue placement, or recording sounds produced and listening to those recordings. Feeding therapy techniques may involve modifying flow rates through changes in bottles, cups, or positioning. An expert speech-language pathologist from Verse therapy can help get you started. Get Personalized Online Speech Therapy for Every Stage of Life.

Supporting Your Child's Speech Journey

It is important for caregivers to be part of the therapy process and to understand the therapy activities. Success in therapy will be dependent on practicing, and parents will need to encourage and participate in that practice. Home activities will be provided by the therapist, and progress on those activities will be monitored in therapy sessions.

When to Seek Professional Help

At the earliest signs of difficulty with breast or bottle feeding, an assessment should be conducted. In an older child, if they struggle with producing certain sounds or demonstrate reduced communication, they should receive an expert evaluation before they can develop habitual patterns that become harder to fix. An expert SLP can evaluate the oral cavity in terms of structure and function. They will also test articulation skills as compared to typical peer development.

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