What is Tongue-Tie and How is it Treated?

By: Valerie Heneghan, M.A. CCC-SLP/L

The topic of tethered oral tissues or tongue/lip tie is evolving and controversial among professionals in the medical field.  The controversy often stems from first diagnosis. Is it truly a tethered oral tissue? And second the remediation. Is surgery necessary or is the child able to compensate without intervention? 

As a parent, I know it is a difficult decision as you want the best for your children.  You want to support your child’s development without unnecessary medical procedures.  My suggestion is to work with a professional who has experience in this area who can discuss these considerations and how they impact your child specifically. 

When discussing considerations regarding tethered oral tissues (e.g., tongue, lip, and cheek) it is important to include these 4 components:  

1. Symptoms of mother/infant
2. Mobility
3. Function
4. Location

The conversation on whether to move forward with medical intervention should include symptomology, structures, and function.  One child upon visual inspection may look to have a tethered oral tissue without any symptoms. While another child may have a tethered oral tissue that is not as visually apparent, however may have several symptoms impacting activities of daily living.

Below are interdisciplinary symptoms that could potentially be attributed to tethered oral tissues that you may want to consider:

• Breastfeeding issues: Nipple pain, difficulty latching, inefficient nursing (e.g., feeding until becomes fatigued rather than full, nursing around the clock, etc.)
• Lack of weight gain or growth
• Difficulty moving to solid foods or won’t tolerate a variety of foods
• Difficulty with cup, straw or bottle drinking
• Delayed production of single words or imprecise articulation
• Dentition (e.g., gap in front teeth) or malocclusion
• Open mouth posture or congestion
• Asymmetrical motor skills (e.g., preference for one side at young age) or Torticollis
• Issues with sensory regulation, fine motor skills or vision
• Coordination or balance issues
• Gut Health issues or GERD
• Sleep apnea

What are the next steps? 

It is important to find a medical professional who has experience in this area. A Pediatrician, ENT, or Dentist can diagnose a tethered oral tissue.  Often a Speech-Language Pathologist or Lactation Consultant may be referred, as these professionals work closely with oral motor skills therapeutically.

If a frenectomy (i.e., surgical cut to release the frenulum) is warranted, seek a medical professional (e.g., ENT or Dentist) who has experience in the following:

• Has knowledge and expertise in releasing tethered oral tissues  
• Recommends post-surgical program (i.e., stretches, therapeutic feedings, etc.)
• Procedural experience using both scissor and laser for best possible outcome.

For more information on Easterseals DuPage & Fox Valley Speech-Language services, including those that treat children with Tongue Tie conditions, visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/speech-language-therapy.html