Tongue Tie

A lingual frenum / lingual frenulum is a band of tissue that connects the tongue to the floor of the mouth.  Sometimes a frenulum is too short or tight, which makes it difficult for infants to breastfeed or suck from a bottle.  Later, it may be difficult for a toddler or older child to accurately say speech sounds.  For example, if the tongue tip does not have good vertical range of motion, it may be difficult to say sounds like: t, d, n, and l accurately, especially in rapid conversation. 
In this situation, a child may say these sounds with the blade of his tongue, instead of the tongue tip, resulting in imprecise speech.
Lactation consultants are often the first to raise concern about a tight frenulum, and speech therapists should always check a child’s mouth to see if this is the root of articulation errors. 
When a speech-language pathologist is concerned a child’s frenulum is tight, a referral may be made to a pediatric otolaryngologist (AKA Pediatric Ear, Nose and Throat Physician / ENT).  A telling sign that the frenulum is tight is that the tip of the child’s tongue is heart shaped.  The frenulum is pulling so tightly, it is distorting the shape of the tongue tip.
If the Pediatric ENT agrees the frenulum is too tight, (AKA “tongue tie” or more formally, ankyloglossia) he may recommend cutting the frenulum (frenulectomy).  This is usually done under general anesthesia with young children.  As the frenulum of a newborn is thin, the procedure may involve only an incision.  With older children, the thick frenulum is cut and suture repairs are often necessary. 
Speech therapists can recommend exercises to try to stretch the frenulum, which requires diligent, consistent practice.

After a tight frenulum is clipped or stretched, a child may require articulation therapy and / or oral motor therapy to help the child achieve accurate placement of the jaw, lips and tongue for speech sounds.

I am a private speech therapist specializing in articulation disorders in New York City, in children’s homes on the Upper East Side. You can contact me, Stephanie Sigal, at 646-295-4473 or