Do Tongue Ties Impact Speech?

Do tongue ties impact speech later in life? I’ve heard they can cause language delays and other issues. Is that true?

— Anonymous

First, let’s address the difference between speech and language. Language pertains to our ideas and the messages we communicate, whereas speech is the act of verbalizing them. We do not need to speak in order to use language when we are communicating. Do tongue ties cause speech or language delays? We have not found that to be true. However, there is a valid concern about the presence of a tongue tie for feeding.

A child presents with a “tongue tie” when they are born with a shortened frenulum, which is that little piece of tissue that connects the bottom of your tongue to the floor of your mouth. Prevalence of a tongue tie ranges from 0.1% to 12% and manifests in approximately 5% of infants, often independently of any additional craniofacial difference such as a cleft lip or palate. They are more common in males than females in a 3:1 ratio because of a known genetic link to the X chromosome. As a speech-language pathologist, it is not within my scope of practice to tell you what “shortened” means in terms of length and tightness, as that is information an otolaryngologist (ENT) would be responsible for evaluating and diagnosing. What could be a sign that your child’s frenulum is tighter than expected would be if the tongue tip cannot lift toward the upper teeth/gums easily or if they are having significant trouble moving their tongue side to side.

Eating and drinking require us to lift, lower, protrude (stick out), and retract (pull in) our tongue freely so that we can safely ingest and swallow different textures. Therefore, a frenulum that is too short or too tightly attached to the floor of a child’s mouth can lead to a variety of concerns, including choking, a blocked airway, reduced food intake, nausea, frustration, and fatigue, in addition to poor nipple attachment and sucking. Frenotomy and myofunctional therapy — a non-surgical alternative that includes a series of exercises aimed at supporting the coordination and positioning of the teeth, tongue, jaw, and lips — are interventions typically recommended to release the tongue tie for feeding. Consult with a multidisciplinary team of specialists, including physicians and a speech-language pathologist that you trust, to determine the best treatment plan for your child.

While the aforementioned tongue movements are necessary for both feeding and speaking, there is no evidence proving that a tongue tie causes articulation difficulties or speech delays. What we do know is that most children and adults with a shortened frenulum can compensate naturally to produce speech sounds that require tongue tip elevation, such as /l/, /t/, and /s/, without affecting intelligibility. Ongoing multidisciplinary research is being conducted to explore this relationship further. Additionally, there has been no research that demonstrates myofunctional therapy and/or a frenotomy on their own will correct speech sound disorders of any severity.