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My Child Has Tongue Tie?

 

Tongue tie or short tongue is often associated with misarticulation or speech delay. Tongue tie occurs when the thin muscle under the tongue or frenelum is too short. This will limit tongue movement and will interfere with the function of the tongue.

Four main functions of the tongue are speech, breastfeeding, digestion and social activities.

“If your child’s tongue is not able to function normally, please bring him/ her to see a specialist for early intervention.”


Short frenelum
Source: www.ghorayeb.com

These are the physical characteristics of tongue tie:

  • Unable or have difficulty to protrude the tongue
  • Tip of the tongue is flat, heart-shaped or split
  • Unable or have difficulty to move tongue to the left and right
  • Tip of the tongue is unable to reach the hard palate/ roof of the mouth
  • Tip of the tongue is unable to lick upper lips
  • Unable to roll tongue backwards
Tongue Function
Normal Tongue
Tongue Tie/ Short Tongue
Speech

Tongue muscles are capable of different movements such as expanding, shrinking, rolling and changing its shape to produce different speech sounds.

For example: “High Vowel” refers to the sound produced when the tongue is curved towards the roof of the mouth and “Low Vowel” is produced when the tongue is situated low and flat in the mouth.

A short frenelum will affect the quality of a child’s speech sound production. The limited movement of the tongue will cause:

  • Misarticulation
  • Irregular speech rate
  • Disrupted intonation and rhythm
  • Imprecise speech
Chewing and swallowing

The tongue is also important during digestion of food in the mouth:

  • Tongue is the organ for the sense of taste
  • Sucking liquid and chewing food (the tongue works together with the cheek muscles to move food in the mouth, and control movement of food between upper and lower teeth until all food is completely chewed)
  • Clear food residue from mouth
  • Children with tongue tie may fail or have difficulty with food manipulation in the mouth. They will reject food that has difficult textures to process.
  • Dental caries (tooth decay) can happen because the tongue is unable to clear food residue from between teeth, under tongue or space between gums and cheek.
Breastfeeding Comfortable feeding

Your baby may have a tongue tie if:

  • Fail or have difficulty sucking from a nipple/ pacifier causing him/ her to have insufficient optimal nutritional intake
  • Mother’s nipple may wound or have blisters during breastfeeding
Social activities The tongue is used in social activities such as signaling, blowing, licking and others.
  • Children in particular may not be able to take part in routine play and use of signals that involve tongue movement
  • Older children may feel embarrassed or have low self-esteem with their tongue problems because it’s hard for them to say certain words

Role of Speech-Language Therapist

Step 1: The Speech-Language Therapist will assess and record new patient information as below:

  • Patient demographic/ information (name, age, family background, etc.)
  • Family history
  • History of eating and early feeding skills
  • Current feeding skills
  • Tongue movement
  • Oral hygiene
  • Saliva control
  • Speech assessment
  • Language development

Step 2: The therapist will determine the need for surgical intervention

  • If surgical intervention is needed, the patient will be referred back to your medical practitioner

Step 3: The therapist will plan for therapy objectives after surgery.

Facts on Surgical Intervention

  • Not all patients with tongue tie will need to undergo surgical intervention.
  • Surgical intervention will be performed only if necessary.
  • In addition to patient/ caregiver complaints, evaluation from medical practitioner and therapist will further determine if the patient will need to undergo surgery to release his/ her frenelum. Surgery will be performed only with patient/ caregiver consent.
  • Surgical intervention involves cutting away tissue and anesthesia by a specialist.

Goal of Tongue exercises after Surgical Intervention:

Purpose of exercises:

  • Shaping the tip, height and protrusion of the tongue in and outside the mouth.
  • Increase kinesthetic awareness to know other parts of the mouth and what can be done in terms of structure and texture.
  • Trains the tongue for movements related to cleaning the oral cavity

The following are suggested tongue exercises:

  • Move the tongue in and out of the mouth. Repeat 10x.
  • Stretch the tongue towards the nose, and then bring it down towards the chin. Repeat.
  • Lick lower lip and upper lip with the tip of the tongue in an open-mouth position. Repeat 10x. This can be done separately. You can also try to put jam or flavoring on the lip to increase your child’s interest in the activity.
  • Push inner cheeks with tongue.
  • Move tongue to the right and left corner of the lips.
  • Move tongue to touch the roof of the mouth (hard palate)

Tips for Tongue Exercises

Tip 1 : Discuss with a Speech-Language Therapist before proceeding with any exercises. Recommendation from a therapist is utmost important so that the exercise fits the needs of your child.

Tip 2 : Do the exercises with your child in a fun and enjoyable way.

Tip 3 : Do the exercises as long as 5 to 10 mins for two to three times each day.

Tip 4 : Use pictures, videos and be a good model by showing how to perform the exercises correctly and precisely.

Tip 5 : Encourage and praise your child for his/ her efforts

Tip 6 : Include other family members in the activity to increase participation

“Will my child’s speech be normal if he/ she does tongue exercise without surgical intervention?”

Tongue exercises alone may not guarantee that speech quality will get better as there are other factors that may affect one’s articulation.

Seek help from a Speech-Language Therapist in the nearest hospital for an assessment.

References:

  1. Carmen.F (1998). Tongue Tie- From Confusion to Clarity: A Guide to the diagnosis and Treatment of Ankyloglossia. Publisher: Tandem Publications
  2. Dental Health (2011). Tongue-tie. Retrieved from  http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Tongue-tie

 

Last Reviewed : 10 October 2016
Writer : Norhafillah bt Abdul Rahman
Translator : Angela Yew Wei Ching
Accreditor : Fairus bt. Mukhtar