The information provided here is based on clinical experience of myself and others. There is LIMITED research on the impact of tongue tie on speech. More studies have been completed investigating the effect of tongue tie on breastfeeding, but that information is inconclusive.
Clinical experience is a part of Evidence-Based Practice and is necessary when the research has not caught up to the needs of the patient. All of our patients receive a FULL FUNCTIONAL evaluation lasting 1-2 hours before any recommendations are made to medical doctors regarding tongue tie impact and the need for correction (surgery).
My experience in Early Intervention and private practice over the last five years has led me to realize tongue tie MAY be more of an issue than I ever expected and it is largely ignored.
The number of children I have seen with suspected tongue tie continues to amaze me on a daily basis. The number of children referred for feeding difficulty is on the rise and I have to ask myself "Is it because tongue tie is no longer corrected?" The answer is most likely YES!
If you serve children or have children, start looking at what they eat. You will notice too many children are on a 'soft' food diet. Everything is mushy without a lot of chewing. This is not good not only in terms of feeding and chewing, but oral development and speech!
Below you will find a website that will start you on the journey to understanding tongue tie, lip ties, and the struggles those affected face on a day to day basis.
In my workshops, it is common to hear a collective sigh from the SLPs because someone FINALLY said: "Yes, tongue tie CAN impact speech!" Will it impact ALL children? NO!
Unfortunately, research in this area is lacking. Some articles show impact in breastfeeding and speech, but the results are inconclusive and more research is needed!
Clinical experience is showing improvement in outcomes after release for both speech and feeding.
This was a child enrolled in therapy for /r/ who struggled producing this sound. After surgery she was able to produce /r/ the next day.
(Parent permission for posting here has been granted.)
So many SLPs have struggled with children not making progress and wondered why they could not correct their errors. It seemed the usual bag of tricks did not work for these kids. This leads to serious self-esteem issues for both the child and the SLP!
Have you ever had a child like that?
If you have practiced long enough, I bet you have!
So, what is our role?
Unfortunately, this vague statement refers to the "decision", but not evaluation or diagnosis of tongue tie for SLPs.
Here is ASHA's position statement:
The decision to clip the frenulum is a medical decision made by physicians and is not in the scope of practice for speech-language pathologists. The SLP may play an evaluation and treatment role from a speech, feeding, or swallowing standpoint, but ultimately the decision--as it is a medical procedure--is up to the physician.
So what are SLPs supposed to do?
First, SLPs MUST be trained in assessing for tongue tie.
Second, a COMPLETE history from birth must be obtained in addition to a FULL FUNCTIONAL assessment of tongue mobility. This may or may not include information on feeding or a feeding assessment if this is an area of concern.
Most SLPs automatically refer to ENTs for these procedures, but dentists are actually performing more revisions then ENTs. There are ENTs out there too, but you must do your research. Find doctors who are performing these procedures routinely and not every other month. Not all doctors are equal when it comes to correcting tongue tie.
If you want to know more, please consider joining the Facebook Groups listed below.
Tongue Tie Babies Support Group:
Speech Therapy & Tongue Tie:
Tongue Tied Adults Support Group:
Learn more Tongue Tie signs and symptoms of uncorrected tongue tie listed below
Realize the evidence base in this area is so limited, but that does not mean we cannot help children and that the condition should be ignored. The anecdotal clinical evidence provided by the leaders in the field (dentists and a few ENT's) is also part of the evidence base and is overwhelmingly positive!
As SLP's, it's time we realize having a MAJOR articulator anchored to the bottom of the mouth is NOT good for so many reasons.
Will everyone that is tied have speech issues? No! However, they will ALL have oral swallowing difficulty that will lead to so many other problems including facial development. Ever wonder why EVERY teen seems to need braces today? What is going on with orofacial development?