Parents often worry that tongue tie causes persistent speech problems. This article separates myths from evidence, explains how tongue tie can — and often cannot — affect feeding and articulation, and gives practical home strategies for boosting toddler language. Learn clear referral signs, safe oral-motor activities, and when to consider evaluation by a speech-language pathologist or pediatric ENT.
What tongue tie is and how it is evaluated
Ankyloglossia is the medical term for the condition commonly known as tongue tie. It is a congenital physical trait where the lingual frenulum is shorter or thicker than usual. This frenulum is the small fold of mucous membrane that connects the underside of the tongue to the floor of the mouth. When this tissue is too restrictive, it can limit the range of motion of the tongue. This limitation can interfere with various oral functions. It is important to understand that the presence of a frenulum is normal. Every person has one. The diagnosis of a tie only applies when that tissue significantly hinders movement.
Clinicians generally categorize tongue ties into two main variants. Anterior tongue tie is the most recognizable form. In these cases, the frenulum attaches near the tip of the tongue or at the midline of the tongue surface. It is often visible to the naked eye during a basic exam. Posterior tongue tie is more complex. This variant involves a frenulum that is thickened or attached further back. It is often hidden underneath the lining of the mouth. Because it is submucosal, it may not be obvious during a simple visual inspection. A posterior tie can still create significant tension and restrict the tongue even if it does not look like a classic tie.
Several classification systems help professionals describe the anatomy they see. The Coryllos system is a frequent choice in clinical settings. It divides tongue ties into four types. Type I and Type II are anterior ties where the attachment is at the tip or just behind it. Type III and Type IV are posterior ties where the attachment is further back or completely under the tongue base. Another widely used tool is the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF). It provides two separate scores: one evaluates the physical appearance of the tongue, and the other evaluates how the tongue actually functions. Experts often recommend a function score of 11 or less as a threshold for considering intervention. Some providers also use the Kotlow classification. This method measures the length of the free tongue in millimeters. A measurement of less than 16 millimeters is typically viewed as a sign of restriction.
Estimates of how many children have tongue tie vary significantly. Research suggests the prevalence ranges from 0.1 percent to 10.7 percent of newborns. This wide range exists because there is no single universal standard for diagnosis. Some studies focus only on obvious anterior ties, while others include posterior variants. Prevalence also seems higher in infants than in older children, suggesting that some mild restrictions might resolve or become less noticeable as the mouth grows. Data consistently shows that boys are more likely to have tongue tie than girls, with the ratio often cited as three to one. In the United States, the number of diagnoses increased by over 800 percent between 1997 and 2012. This spike is likely due to increased awareness and a stronger focus on the mechanics of breastfeeding.
Evaluating a tongue tie requires looking beyond appearance. A tongue might look tied but still move perfectly. Clinicians prioritize functional assessment over visual inspection. This process starts with a detailed feeding history. For infants, this includes looking for difficulty latching or maternal nipple pain. For toddlers, it involves checking how they manage different food textures. A physical oral motor exam is the next step. The clinician will test the range of motion in several directions. They check for protrusion (sticking the tongue out past the lower lip), elevation (lifting the tongue tip to the roof of the mouth), and lateralization (moving the tongue to the corners of the mouth or the molars).
Common Observational Signs
There are specific signs that suggest a functional restriction. A heart-shaped tongue tip when the child tries to stick it out is a classic indicator. You might also see a notch or a cleft at the tip. During crying or feeding, the tongue might stay low in the mouth rather than lifting. Some children show an inability to clear food from their side teeth. In babies, a clicking sound during nursing or frequent loss of suction can point to a tie. However, these signs must be viewed in the context of the whole oral exam. Appearance alone is a poor predictor of whether a child will have speech or feeding issues.
The Importance of a Multidisciplinary Team
Because tongue tie affects different areas of development, a team approach is best. A pediatrician provides the initial screening and monitors overall growth. A lactation consultant is essential if there are breastfeeding concerns. They can determine if feeding issues are due to the tie or other factors like positioning. A speech-language pathologist evaluates how the tongue moves for speech sounds and swallowing. If surgery is considered, a pediatric ENT or an oral surgeon provides the structural expertise. This collaboration ensures that a procedure is only performed when a clear functional need exists. It also helps families avoid unnecessary surgery for ties that are not causing problems.
| Evaluation Domain | What the Clinician Checks | Functional Goal |
|---|---|---|
| Protrusion | Tongue extension past the lower gum or lip | Ability to stick the tongue out for cleaning and speech |
| Elevation | Tongue tip reaching the alveolar ridge (roof of mouth) | Essential for sounds like T, D, N, and L |
| Lateralization | Tongue movement to the left and right molars | Moving food across the mouth for safe chewing |
| Feeding Observation | Latch quality, suck strength, and swallow coordination | Efficient milk transfer and comfortable feeding |
Current guidelines from organizations like the American Academy of Pediatrics and the Academy of Breastfeeding Medicine emphasize conservative management. They suggest that lactation support should be the first step for feeding issues. The Royal College of Paediatrics and Child Health in the UK and the Canadian Pediatric Society also advocate for careful functional assessment. Evidence for treating posterior tongue tie is still considered limited and evolving. Many professional statements highlight the need for more high-quality research on long-term speech outcomes. While some children benefit greatly from a release, others may find success through therapy alone. The decision should always be individualized based on the specific functional challenges the child faces.
How tongue tie can affect feeding, oral development, and speech
The impact of a tongue tie often begins long before a child starts to form their first sentences. It frequently appears in the first days of life during breastfeeding. Research indicates that mothers of infants with a tongue tie report breastfeeding struggles about 55 percent of the time. This is notably higher than the 42 percent reported by mothers of infants without the condition. The most common issues include a shallow latch plus significant nipple pain. While a release procedure often reduces maternal pain within 48 hours, the data on actual milk transfer is less consistent. Some studies show an increase in milk volume while others show no change. This suggests that while the mother feels better, the mechanical efficiency of the swallow might not always shift immediately. You can find more details on these early signs at NYC Tongue Tie.
As a child grows, the focus shifts toward oral motor development. You might notice your toddler struggling to move food around their mouth or clearing it from their cheeks after a meal. There are theories that a restricted tongue can lead to dental issues like a narrow palate or an open bite. However, the evidence here remains limited. Longitudinal studies have not yet proven a direct cause-and-effect relationship between tongue ties and long-term dental alignment. Most experts agree that while a tie might influence how a child chews, it is rarely the sole cause of major orthodontic problems.
Speech concerns usually become the main topic of conversation around the second birthday. This is the window when toddlers move from simple vowels to complex consonants that require the tongue tip to lift. The sounds most likely to be affected are those made at the alveolar ridge. These include t, d, n, and l. Sibilant sounds like s and z are also frequently impacted. If the tongue cannot reach the roof of the mouth, the child might develop compensatory patterns. They might use exaggerated jaw movements to help the tongue reach its target. They might also substitute sounds made with the lips for sounds that should be made with the tongue.
Speech Sounds and Mechanical Limits
The following table outlines the sounds most commonly affected by restricted tongue mobility and the typical age they emerge in a child’s vocabulary.
| Sound Category | Specific Sounds | Typical Age of Mastery |
|---|---|---|
| Alveolar Sounds | t, d, n, l | 2 to 4 years |
| Sibilants | s, z | 3 to 5 years |
| Interdentals | th (voiced and unvoiced) | 4 to 7 years |
Interestingly, the r sound is less likely to be affected by a simple anterior tie. Producing a clear r often depends more on the back of the tongue shaping correctly. Many children with a visible tie can still produce a perfect r sound. This is why a functional assessment is more important than just looking at the shape of the tongue. Research summarized by Dr. Cara Goodwin suggests that many children with tongue ties show no difference in speech intelligibility compared to their peers.
The Reality of Surgical Intervention
The evidence regarding surgery for speech improvement is mixed. Many case studies show better articulation after a release, but these results are often modest. A major factor is that surgery alone does not teach a child how to move their tongue in new ways. Most successful outcomes involve a combination of a procedure plus targeted speech therapy. The therapy helps break the old compensatory habits the child built while their tongue was restricted. For older toddlers and children undergoing a frenuloplasty, the expected timeline includes one to two weeks of localized discomfort. It may take several months of therapy to see a significant shift in how they produce sounds in conversational speech.
Risks and Recovery
In infants, the procedure is very quick and often done with a laser or scissors in an office setting. For toddlers, it may require general anesthesia to ensure the child stays still. Complication rates are low, usually under 2 percent. The most common risks include minor bleeding or the tissue growing back together. Doctors often prescribe oral stretches to prevent the area from reattaching during the healing phase.
Clinical Red Flags for Expedited Evaluation
Certain signs suggest that a tongue tie is truly limiting function. These red flags justify a prompt evaluation by a professional team.
Feeding and Growth Concerns
A decline in weight percentiles or a persistent inability to latch despite professional lactation support are major concerns. If an infant cannot protrude their tongue past their lower lip by several months of age, it indicates a significant mechanical restriction. This often leads to inefficient feeding and fatigue during meals.
Oral Motor and Chewing Signs
Difficulty clearing food from the molars or frequent gagging on textures can be linked to limited lateral tongue movement. You might also see a heart-shaped or notched tongue tip when the child tries to stick their tongue out. These physical signs are more concerning when they are paired with a struggle to eat a variety of food textures.
Speech and Intelligibility Milestones
If a child has no single words by 15 months or fewer than 50 words by 24 months, a referral is necessary. Specific to tongue ties, look for a persistent inability to produce alveolar sounds even with consistent therapy. If the child uses a flat tongue for all sounds or relies heavily on jaw jutting to speak, the restriction may be the primary cause. A child who is less than 50 percent intelligible to strangers at age 2 should be evaluated by a speech-language pathologist to determine if the issue is structural or developmental.
It is important to be honest about what the science says as of recent clinical updates. High-quality randomized trials on tongue tie and speech are still scarce. Many studies are small or lack a control group. This makes it hard to say for certain that a procedure will fix every speech delay. Professional organizations suggest a cautious approach. They recommend focusing on functional impairment rather than just the appearance of the frenulum. A multidisciplinary team including a pediatrician, a speech-language pathologist, and an ENT provides the most balanced view. This ensures that surgery is only performed when it is truly necessary for the child’s long-term development.
Practical home strategies to boost toddler speech and when to get help
Supporting your toddler’s speech at home is about making small changes to things you already do every day. You do not need expensive toys or a classroom setup. Most of the best work happens during breakfast or while you are playing on the floor. If you are worried about a tongue tie, these strategies help build the strength and coordination your child needs regardless of whether they have a procedure.
Speech Milestones and Red Flags
Tracking progress helps you decide when to seek professional help. The following table outlines what most children achieve between twelve and thirty-six months.
| Age | Typical Milestones | Red Flags for Referral |
|---|---|---|
| 12 Months | Uses first words like mama or dada. Responds to their name. | No babbling or gesturing by ten months. |
| 18 Months | Has a vocabulary of twenty to fifty words. Uses single words to communicate needs. | No single words by fifteen months. |
| 24 Months | Uses fifty or more words. Starts putting two words together. | Fewer than fifty words. No two-word combinations. |
| 30 Months | Vocabulary expands quickly. Uses some three-word phrases. | Speech is less than fifty percent intelligible to strangers. |
| 36 Months | Most consonants are emerging. Speech is seventy-five percent intelligible. | Persistent frustration when trying to speak. |
Daily Routines as Language Lessons
Mealtime Narration
Talk about what you are doing while you prepare food. Use simple phrases like big spoon or cold milk. This helps your child link words to objects in real time. If they have a tongue tie, encourage them to use their tongue to clear food from their lips. This builds lateral movement naturally.
Book Reading Scripts
Do not just read the words on the page. Point to pictures and wait for your child to react. Ask where is the cat and give them five seconds to respond. If they point, say yes, the orange cat. This encourages turn-taking which is the foundation of conversation.
Action Songs
Songs like The Itsy Bitsy Spider or Head, Shoulders, Knees, and Toes combine movement with language. These help toddlers understand verbs and body parts. Pause before the last word of a familiar line to see if your child fills it in.
Play Ideas for Sounds and Vocabulary
- Bubble play helps with lip rounding and breath control.
- Blowing whistles or party blowers builds respiratory support for longer sentences.
- Straw drinking encourages the tongue to pull back and strengthens the back of the mouth.
- Sticky foods like a tiny bit of peanut butter on the corner of the mouth encourage tongue lateralization.
- Hide and seek with toys allows you to practice location words like under or behind.
- Imitation echo games involve you repeating the sounds your child makes to encourage more vocalization.
- Sound hunts involve finding three things in the room that start with a specific sound.
- Puppet play is excellent for practicing turn-taking and social language.
- Snack assembly lets you use sequencing words like first and then.
- Obstacle courses help children follow multi-step directions while moving.
Safe Oral Motor Exercises
The Tongue Lick
Ask your child to run their tongue along their lips as if they are licking off sprinkles. This promotes range of motion.
Roof Touches
Encourage your child to touch the tip of their tongue to the bumpy ridge behind their top teeth. This is the spot needed for sounds like t and d.
Tongue Sweeps
Have your child move their tongue from left to right along their teeth. This mimics the movement needed for chewing and certain speech sounds.
Straw Sips
Use a thin straw for small sips of water. This requires the tongue to stay in a retracted position.
Pudding Retrieval
Place a small dot of yogurt on the upper lip. Ask the child to reach up with their tongue to get it.
Bubble Pops
Have the child blow air into their cheeks and then pop them with their hands. This builds cheek strength.
Precautions for exercises. Stop if your child gags or seems in pain. Never force the tongue into a position. These should feel like a game rather than a chore.
Integrating Strategies with a Frenotomy
If you choose a frenotomy, the procedure is only one part of the process. Research on the prevalence of tongue tie and speech sound disorders suggests that the procedure alone may not fix articulation. You should start gentle tongue exercises about twenty-four hours after the release. This helps prevent the tissue from reattaching too tightly. You might see better tongue movement in one week. Speech changes usually take four to twelve weeks of consistent practice. It is crucial to ask your provider for a specific post-operative plan, including pain management and a schedule for tongue exercises.
When to Get Professional Help
Contact a speech-language pathologist if your child meets any of the red flags in the milestone table. You should also seek an evaluation if your child seems to struggle with the physical act of moving their tongue. A pediatric ENT or oral surgeon is necessary if the frenulum physically prevents the tongue from reaching the roof of the mouth.
When you prepare for an evaluation, bring a list of your child’s current words. Record a short video of them eating and speaking at home. This gives the professional a view of their natural behavior. Ask the provider about the expected functional gains and what the recovery timeline looks like for your specific child.
Measurable Goals for Home
Vocabulary Goal
Your child will use five new nouns during playtime over the next four weeks.
Articulation Goal
Your child will attempt a target sound like t or d five times during a ten-minute play session.
Intelligibility Goal
Family members will understand ten percent more of the child’s spontaneous speech within two months of starting daily routines.
Family-friendly therapy often uses a sound play approach. This means we do not drill sounds like a test. We embed the target sounds into games so the child stays engaged. This builds confidence while they learn to navigate their new range of motion.
Conclusions and next steps for parents
Understanding tongue tie requires looking past the physical appearance of the frenulum. It is a structural difference that varies from child to child. While it can impact early feeding or specific speech sounds, it does not always lead to long-term speech struggles. The most important takeaway from current research is that we must look at function over appearance. If your child can lift their tongue to the roof of their mouth or move it to the sides without trouble, the tie may not be a factor in their language development. Many children with a visible tie speak perfectly fine because they have learned to compensate with their other oral muscles.
Evidence regarding routine surgery for speech is still mixed. While some families see immediate changes, many studies show no significant difference in speech clarity after a release alone. This study found no significant difference in speech production between children with and without tongue tie. This is because speech is a motor habit. Even if the physical restriction is removed, the brain and muscles still need to learn the correct movements. This is why a combined approach is so vital. Surgery without follow-up therapy often fails to produce the results parents hope for. A frenotomy might provide the range of motion needed, but speech therapy provides the skills to use that motion effectively.
Credible Resources and Directories
Finding the right help in the USA is easier when you know where to look. The American Speech-Language-Hearing Association (ASHA) maintains a directory called ProFind. This tool allows you to search for certified speech-language pathologists in your area who specialize in pediatric feeding or articulation. The American Academy of Pediatrics (AAP) also provides resources for finding pediatricians and specialists who follow evidence-based guidelines. For surgical concerns, the American Academy of Otolaryngology—Head and Neck Surgery offers a directory of pediatric ENT specialists.
When consulting providers, it is helpful to verify insurance coverage for CPT codes 40815 or 41010, which are commonly used for these procedures. You will likely need a referral and a report from a speech therapist to secure coverage. Using these professional organizations ensures that the providers you consult are held to high clinical standards. Always ask potential providers about their experience with ankyloglossia and their philosophy on combined therapy approaches. This helps you find a partner who values a conservative and functional approach to your child’s care.
References
- [PDF] Prevalence of tongue-tie and evaluation of speech sound disorder in … — In this study, no significant difference in speech production was found between children with and without tongue-tie [20]. It is worth to …
- Could a Tongue Tie Be the Reason for Your Child's Speech … — Research suggests that between 4% to 11% of newborns are born with a tongue tie, although the actual prevalence may be higher due to …
- The Research on Tongue Ties – by Dr. Cara Goodwin, PhD — A recent study found no difference in speech production or intelligibility in children after releasing a tongue tie.
- Do Tongue Ties Impact Speech? | ParentData by Emily Oster — Prevalence of a tongue tie manifests in approximately 5% of infants, often independently of any additional craniofacial difference such as a …
- Tongue-Tie, What Is It? And Should I Do Something About It? — Tongue-ties are often associated with children who have difficulties with feeding and/or speech production. Tongue-ties impact about 3-16% of infants worldwide …
- Ankyloglossia (Tongue-Tie) – StatPearls – NCBI Bookshelf – NIH — Ankyloglossia, also known as tongue-tie, is a condition that impairs tongue movement due to a restrictive lingual frenulum.
- AAP Addresses Rise in Tongue-Tie Diagnoses for Breastfeeding … — The rate of ankyloglossia diagnoses in newborns range from 1.7% to 10.7%, according to three different studies focused on diagnoses in the …
- Tongue-Ties: To Clip or Not To Clip… That is the Question! — At Speech Sisters, research has shown the prevalence of tongue ties in newborns is anywhere between 4 and 11 percent.
- Ankyloglossia: Incidence and Associated Feeding Difficulties — Fifty of the 1041 newborns screened were found to have ankyloglossia, yielding an incidence rate of 4.8%. Thirty-six of the affected newborns were male, and 14 …
Legal Disclaimers & Brand Notices
The information provided in this article is for informational and educational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, pediatric ENT, speech-language pathologist, or other qualified health provider with any questions you may have regarding a medical condition, surgical procedure, or recovery protocol. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
All product names, logos, and brands are the property of their respective owners. All company, product, and service names used in this article are for identification purposes only. Use of these names, logos, and brands does not imply endorsement.