If your child has been diagnosed with a tongue tie, you've probably been told it could be the reason behind their speech delays, feeding struggles, or articulation issues. The reality is more nuanced, and understanding the research can help you make better decisions for your child.
What Is Tongue Tie, and How Is It Classified?
Tongue tie, clinically known as ankyloglossia, occurs when the lingual frenulum (the small band of tissue connecting the underside of the tongue to the floor of the mouth) is shorter, thicker, or tighter than typical. This restriction can limit tongue mobility in ways that affect feeding, speech, and oral function.
Tongue ties are typically classified on a scale from Class I through Class IV. Class I and Class II ties are anterior and more visible, attaching near the tip of the tongue. Class III and Class IV ties are posterior and often missed on initial exams because they sit further back and may be submucosal, meaning they're beneath the surface tissue. Posterior ties (Class III and IV) are more controversial in the research, partly because they're harder to diagnose consistently and their functional impact varies widely from person to person.
Not every tongue tie causes problems, and not every speech or feeding problem is caused by a tongue tie. That distinction matters enormously when it comes to deciding on treatment.
When Does Tongue Tie Actually Affect Speech?
This is where the evidence gets important. Research does support a connection between tongue tie and certain speech sound errors, but it is not a blanket relationship. The sounds most commonly affected are those that require the tongue tip to elevate or make precise contact with the alveolar ridge (the bony ridge just behind the upper front teeth). These include sounds like L, R, S, Z, Th, T, D, and N.
If the frenulum prevents the tongue from reaching the roof of the mouth or the alveolar ridge with enough mobility, producing these sounds clearly becomes mechanically difficult. However, many children with tongue ties compensate effectively and develop typical speech with no intervention. Others develop compensatory patterns that, over time, can become habituated and harder to change.
What the research does not support is the idea that tongue tie is the primary driver of most speech delays. Global language delays, phonological disorders, and expressive language issues are driven by different mechanisms entirely. A proper evaluation by a licensed speech-language pathologist is the only reliable way to determine whether a tongue tie is functionally contributing to a child's specific communication challenges.
The Role of Myofunctional Therapy Before a Release
Here's what many families in the Atlanta area are surprised to learn: a tongue tie release (called a frenuloplasty or frenotomy) on its own is rarely sufficient for resolving speech or feeding issues. In many cases, myofunctional therapy before the procedure is critical to the outcome.
Orofacial myofunctional therapy (OMT) addresses the patterns of muscle use and resting posture in the face, mouth, and throat. Before a release, myofunctional therapy serves two important purposes. First, it helps establish awareness and activation of the tongue musculature that has been restricted. Second, it creates measurable baseline data about the functional limitations present so the clinician can objectively assess improvement after the procedure.
When the tongue has been restricted for months or years, the surrounding muscles often compensate in ways that persist even after the physical tether is removed. If those compensatory patterns aren't addressed proactively, the release may not produce the improvements the family was expecting.
Amanda Smith, MS, CCC-SLP, is certified in myofunctional therapy and conducts thorough assessments to determine whether pre-release therapy is appropriate before recommending or referring for a procedure. Not every child with a tongue tie needs myofunctional therapy first, but the decision should be based on a careful functional assessment, not just the appearance of the frenulum.
What Happens After a Release: Why Therapy Still Matters
Post-release therapy is not optional for most patients. After a frenuloplasty, the tissues heal quickly, and without active mobilization and rehabilitation, scar tissue can form and the frenulum can reattach, partially or fully. This is one of the most common reasons families feel like the release "didn't work."
Post-operative myofunctional therapy typically includes wound care exercises (stretching the release site to prevent reattachment), tongue mobility and strengthening exercises, and retraining resting tongue posture. The tongue should rest on the palate, not on the floor of the mouth, and this positioning often has to be explicitly taught and practiced.
Speech therapy after a release addresses any residual sound errors that persist once mobility is restored. In children, the timing matters. If compensatory articulation patterns have become deeply habituated, they won't self-correct just because the physical restriction is gone. Active speech therapy is needed to reteach correct placement and movement for affected sounds.
The research consistently shows that the best outcomes after tongue tie release come from integrated care: myofunctional therapy before and after the procedure, combined with speech therapy when articulation errors are present.
How to Tell If Your Child Needs an Evaluation
Parents often ask what signs should prompt an evaluation. Here are some functional concerns worth taking seriously, regardless of whether a tongue tie diagnosis has already been made.
For feeding: difficulty latching as an infant, prolonged nursing or bottle feeding sessions, clicking sounds while feeding, gassiness from swallowing air, or trouble transitioning to solid foods.
For speech: consistent difficulty with L, R, S, Th, or other tongue-tip sounds past the age when they are typically acquired, speech that sounds muffled or imprecise, or a tongue that visibly cannot reach the alveolar ridge or elevate to the palate.
For oral habits: chronic open-mouth posture, low tongue resting position, mouth breathing, or persistent thumb or finger sucking that affects dental alignment.
These concerns don't automatically mean tongue tie is the cause. But they do mean a functional assessment by a qualified SLP is warranted.
What Assessment Looks Like at Lasting Language
At Lasting Language Therapy in Sandy Springs, evaluations for suspected tongue tie begin with a comprehensive look at oral structure and function, not just a visual inspection of the frenulum. Amanda assesses tongue range of motion, strength, coordination, resting posture, swallowing pattern, and articulation to build a full functional picture.
From that assessment, the recommendation may be speech therapy alone, myofunctional therapy alone, a referral to a preferred provider for a frenuloplasty with pre- and post-release therapy, or a combination of all of the above. The goal is to match the intervention to what is actually driving the problem, rather than defaulting to a procedure or to watchful waiting without clear criteria.
Families come to Lasting Language from across the Sandy Springs, Roswell, Dunwoody, and Woodstock areas, and telehealth services are available for families who can't make it in for in-person visits.
Getting Started
If you've received a tongue tie diagnosis or are noticing speech or feeding concerns and wondering whether tongue tie could be involved, the right first step is a professional evaluation. Research supports that outcomes improve significantly when therapy and any surgical intervention are coordinated by a knowledgeable SLP who can assess function, not just anatomy.
Amanda Smith is accepting new patients at Lasting Language Therapy in Sandy Springs. Contact the practice to schedule an evaluation and get clarity on what your child actually needs.
