Let’s talk about tongues!
You may have heard of tongue tie before, formally known as ankyloglossia. With around 4-11 percent of new babies being affected by tongue tie (NHS 2017), many parents will have had some experience of it or know someone who has.
What is tongue tie?
Tongue tie occurs when the strip of skin that connects the tongue to the floor of the mouth (frenulum) is too short. There are no known causes for tongue tie. Normally newborn babies will be checked for this upon entering the world. If you lift the tip of your tongue up to the roof of your mouth you will be able see this strip of skin underneath. Now, if this strip of skin was a little bit shorter, it would impact upon the movement of your tongue. For babies with tongue tie, they may not be able to stick their tongue out passed their lower lip or move it from side to side or up and down.
Why are we talking about tongue tie?
We use our tongues to speak, suck, chew, swallow, eat, drink and clear our mouths of food.
As Speech and Language Therapists are trained to recognise any abnormalities within the mouth, we are equipped to identify tongue tie. Having up to date and evidenced based information on tongue tie can help to allay concerns and dispel many myths. As tongue tie is quite common, you may find there is a lot of easily accessible information. When searching the internet for information, always check that the guidance is coming from a reliable source. Some advice may come from friends and family. Keep in mind that tongue tie will affect people differently. Information will also come from your health visitor, midwife or doctor. It is important to remember that whilst tongue tie is very common, the consequences for the individual are not generic and no two experiences will be the same.
So, what do I need to know about tongue tie?
Tongue tie causes restricted movement of the tongue and this may make latching on and feeding troublesome for some young babies (NCT)- Some babies with tongue tie will have no problem with feeding at all. If you think that your baby has tongue tie but are not experiencing any difficulties with feeding, you do not need to take any action. Sometimes tongue tie can be harder to spot, especially if it is posterior (at the back of the mouth), it may therefore go undetected. if you are concerned your child may have tongue tie and it is causing feeding challenges, contact your health visitor or midwife for guidance.
For some children with tongue tie, eating may be a messy business. When we eat, our tongues work hard to collect and push the food from around our gums, teeth and lips to the back of the mouth, so we can swallow it. For some, the restricted motion of the tongue may make this mouth clearing troublesome and parents may find they are having to assist e.g. wiping around the child’s lips after eating a yoghurt.
As a result, food may stay in the mouth and in between the teeth for long periods of time and could impact upon dental health and oral hygiene (Caroline Bowen 2015)
As well as potentially causing feeding issues, some professionals believe that tongue tie can cause difficulties with producing speech sounds. This is widely debated, and the evidence concludes that there is no direct link between tongue tie and speech challenges.
“There is virtually no evidence in the literature to establish a definite causal relationship between ankyloglossia and speech disorders. In fact, there is very little in the literature that addresses ankyloglossia and speech at all. This is probably because a causal relationship is not what is typically seen clinically. (Kummer 2005)
The impact that tongue tie has upon speech is therefore a contentious issue. Some professionals may document that the restricted range of motion of the tongue is having an impact upon a child’s ability to make particular speech sounds. Generally, however, it is thought that speech is rarely affected. Inaccurate articulation of sounds may be more apparent when a child or adult with tongue tie speaks quickly (Caroline Bowen 2015).
The most likely sounds to be affected are below:
- ‘t’,d ’n, l,s,z’ as these all require that the speaker raise the tongue tip to the top of the mouth.
One reason for limited reports of tongue tie impacting upon speech may therefore be due to the way in which the tongue learns to compensate for reduced movement. For example, with t,d,n, whilst many people will raise their tongue tip to make these sounds, they can also be made using the main body of the tongue. L,s,z may be made by pointing the tongue tip down rather than up.).
Treating tongue tie
Treatment will depend upon the severity of tongue tie and to what extent it is affecting feeding or speech. For many, tongue tie will be asymptomatic and no treatment will be required (NICE 2005)
If you are worried that tongue tie is causing your child to struggle with eating of speaking, contact your health visitor, GP or speech and language therapist. If treatment is warranted, then the short frenulum can be cut. This procedure is done following a full assessment and may be carried out under general anaesthetic.
Written by Carolyn Fox, Children’s Speech and Language Therapist
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- Free speech sounds course part 2
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