The Role of Speech-Language Pathologists in Evaluating and Treating Tongue and Lip Ties

by Thriveable Therapies

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Tongue and lip ties, also known as tethered oral tissues, have gained increasing attention in recent years for their potential impact on a child's feeding, speech, and other areas of development and health. A tongue tie (ankylogossia) occurs when the frenulum (the band of tissue under the tongue) is too tight or short, restricting the tongue's range of motion. A lip tie occurs when the upper lip’s frenulum is too tight or short and restricts its movement. While many parents and caregivers are familiar with the idea of a "tongue tie," it can still be difficult to understand exactly how these conditions affect a child’s development—and how different medical professionals play a role in assessing and treating them. 

Besides the potential impact that tethered oral tissues can have on speech and feeding development, there are various other reasons why parents might consider pursuing a tongue or lip tie release surgery, such as issues with breathing, sleep, oral hygeine, dental development, jaw alignment, and body posture. Many different specialists are often involved in assessing and treating tongue ties, such as pediatric dentists, ENTs, lactation consultants, chiropractors, and physical therapists especially when issues such as dental development or breathing are the main concern. However, when speech and/or feeding is the primary reason for pursuing a tongue tie surgery, a specialized speech-language and feeding therapist should be an essential member of the interdisciplinary team assessing and treating the tethered oral tissues and determining if a frenectomy or frenuloplasty (surgical release) is necessary. In this post, we will explore the integral role that speech-language pathologists (SLPs) play in supporting children with tongue and lip ties, particularly regarding their impact on speech and feeding skills.

SLPs Evaluate the Impact of a Tongue Tie on Speech Development

When evaluating a potential tongue tie, SLPs carefully observe how the restriction might affect a child’s ability to form specific sounds, especially those that require the tongue to make precise movements, such as /t/, /d/, /l/, and /r/. Unlike other professionals, SLPs will complete specific speech tasks with your child to determine if the tongue tie is truly affecting their speech, or if another underlying cause such as a speech or language delay or disorder may be the real reason. If that is the case, completing a tongue tie surgery will likely not improve the child's communication skills. 

SLPs Evaluate the Impact of a Tongue Tie on Feeding and Oral Function

A tongue or lip tie may make it challenging for a baby to latch properly for breast or bottle feeding, which can result in ineffective sucking or painful feeding experiences for the mother. Once babies transition to purees and solid foods, tethered oral tissues may make it difficult for them to effectively remove puree off of a spoon, drink from a straw or open cup, and make it difficult for them to move solid foods around in their mouth for proper chewing and safe swallowing. Over time, these difficulties may even lead to food/texture avoidance and picky eating if the child has learned that certain foods are difficult or unsafe for them to manage. 

When evaluating the impact of a potential lip or tongue tie, an SLP is one of the only professionals who will observe the child feeding before making a determination about whether or not the lip or tongue tie is actually affecting the child's feeding. If a lip or tongue tie is suspected to be the cause of feeding difficulties, the SLP will collaborate with other professionals, such as pediatricians, ENTs, or dentists to determine the best course of action. In many cases, the real reason that the child is having feeding difficulties is other than tongue or lip tie such as low tone, weak suck, weak jaw, or sensory differences and can be resolved with feeding and/or myofunctional therapy. If that is the case, completing a tongue tie surgery will likely not improve the child's feeding skills, and may even make them worse. 

Determining the Need for Tongue Tie Release Surgery

An interdisciplinary team is essential when deciding whether a tongue or lip tie release surgery is necessary. If speech and/or feeding development are the primary reasons for completing a surgery, a specialized speech-language pathologist (SLP) should always be part of this team. The SLP should conduct a thorough functional assessment, including an oral examination and direct observation of the child’s speech and/or feeding challenges. It's important to note that not all tongue or lip ties interfere with speech or feeding, and when there is no significant impact, surgery should be avoided. In fact, unnecessary surgery can sometimes worsen speech or feeding issues due to improper healing or damage to important oral tissue. For these reasons, a careful, informed assessment by an SLP is crucial before proceeding with any surgical intervention. Ultimately, the decision to pursue surgery should be made in collaboration with the family and other professionals, considering the severity of the tie and its overall impact on the child's development.

Supporting Minor Tongue Ties Without Surgery

Not all tongue or lip ties require surgery. In some cases, especially when the restriction is minor, SLPs can help children function fully even with the restriction by working on strengthening and coordinating the tongue and surrounding orofacial muscles. This includes exercises that strengthen the tongue, lips, and jaw to improve feeding and speech production. These therapeutic exercises can help enhance coordination and range of motion, making it easier for children to develop the necessary oral skills for eating and speaking. The SLP’s goal is to ensure that the child can function as effectively and comfortably as possible, whether or not surgery is performed.

Myofunctional Therapy Following a Tongue Tie Release

In cases where a tongue tie release surgery is performed, SLPs also play a vital role in supporting the child’s healing and rehabilitation process through myofunctional therapy. Myofunctional therapy is a specialized form of therapy that focuses on improving the function of the muscles used for speech, swallowing, and breathing.

Following a tongue tie release, the child may need to regain strength, coordination, and range of motion in their tongue and other orofacial muscles. Myofunctional therapy helps improve tongue strength, teaches proper tongue posture, and works on techniques to enhance the tongue’s movement for both feeding and speech. This therapy can also address any compensatory behaviors that have developed due to the tongue tie, such as mouth breathing or abnormal swallowing patterns.

Therapists guide children through exercises and activities to ensure the full potential of the tongue tie release is realized, optimizing both speech clarity and feeding skills.

Conclusion

Tongue and lip ties can significantly impact a child’s feeding, speech, and overall oral function. Speech-language pathologists are integral in evaluating the severity of these restrictions and determining the best course of action for treatment, whether that involves therapy, surgical intervention, or a combination of both. By assessing speech, feeding, and oral motor function, SLPs play a key role in helping children develop the skills they need to eat, speak, and thrive. If you suspect your child may have a tongue or lip tie and are concerned about speech or feeding development, working with an SLP can provide valuable insight into the most effective treatment options for your child’s specific needs.

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