Can a tongue tie cause speech problems? What parents should know

A tight tongue tie can make some speech sounds harder, mainly the ones that need the tip of the tongue to lift, such as l, t, d, n, r and th. It rarely causes a general speech delay. An evaluation by a pediatric dentist and a speech-language pathologist (SLP) is the way to find out whether the tongue is part of the problem.

Maybe a preschool teacher mentioned your child is hard to understand, or a relative pointed out that your toddler's tongue looks "stuck." Either way, the question is a fair one. This guide explains what a tongue tie can and can't do to speech, what the research actually shows, and how to decide on next steps without over- or under-reacting.

Which sounds a tongue tie can affect

A tongue tie (ankyloglossia) means the band of tissue under the tongue, the lingual frenulum, is short or tight enough to limit how the tongue moves. Speech depends on fast, precise tongue movement, so a restriction can matter for certain sounds.

The sounds most likely to be affected are the ones that need the tongue tip to rise to the ridge behind the upper front teeth, or to stick out slightly:

• l, t, d and n, made with the tongue tip touching the ridge behind the top teeth
• r, which needs the tongue to lift and shape itself
• th, which needs the tip to reach between the teeth
• s, z, sh and ch, which need fine control of the tongue tip and sides

Many children with a tongue tie speak clearly, because they find other ways to make these sounds. Others substitute one sound for another or sound slightly "mushy." The same child can also be perfectly understandable at home and harder to follow in a noisy classroom.

Speech delay vs. articulation

It helps to separate two things that often get lumped together.

Language is about words and ideas: how many words your child knows, whether they put words together into sentences, and whether they understand what you say. A child with a language delay talks less or uses simpler sentences than expected for their age.

Articulation is about producing sounds: whether the "r" in "rabbit" comes out as "w," or whether "lion" sounds like "yion." A child can have a rich vocabulary and still have trouble with specific sounds.

A tongue tie is a physical restriction, so when it affects speech, it usually shows up as articulation problems with specific sounds. It is not considered a cause of late talking, a small vocabulary or trouble understanding language. If your child isn't talking much yet, the tongue is rarely the main explanation, and an SLP evaluation is the right first step.

Keep in mind that some sounds are among the last to develop. Many children don't produce "r" and "th" correctly until early school age, even with a perfectly mobile tongue. An SLP can tell you whether a sound error is still typical for your child's age.

Signs worth checking

Some signs suggest the tongue may be restricted:

• Your child can't lift the tongue tip to the roof of the mouth with the mouth open
• The tongue tip looks notched or heart-shaped when it sticks out
• The tongue can't reach past the lower lip
• There was a history of feeding trouble as a baby, or picky eating with certain textures now
• Mouth breathing, snoring or restless sleep

For a fuller list of what to watch for, see our article on signs of tongue tie in children. If sleep and breathing are part of the picture too, our sleep and speech check is another quick place to start.

What the research says

This is where honest answers matter. The research on tongue tie and speech is still limited, and studies vary a lot in quality and in how they define a tongue tie.

What can be said fairly:

• A tongue tie does not automatically cause speech problems. Many children with one speak normally.
• In some children with a significant restriction and clear articulation errors, releasing the tie, followed by speech therapy, has been linked with improvement in the affected sounds.
• A release on its own rarely "fixes" speech. The tongue has to learn new movement patterns, and that usually takes practice.
• Speech problems have many possible causes, including hearing, oral muscle tone and normal developmental timing, so a tongue tie should be one part of the evaluation, not the only explanation.

The American Academy of Pediatrics and the American Speech-Language-Hearing Association both encourage a careful, individual evaluation before any procedure for speech reasons. That is the approach we follow too.

Wondering whether your child's tongue could be a factor? Our free 2-minute tongue tie symptom check is a simple first step, and a specialist reviews your answers.

How a release and speech therapy work together

When a tongue tie does seem to be affecting speech, the plan usually has three parts:

1. Evaluation. A dentist or physician experienced with tongue ties looks at how far and how well the tongue moves. An SLP assesses which sounds are affected and whether the pattern fits a physical restriction.
2. Release, if indicated. A frenectomy frees the tongue. At Tooth + Tongue, this is done with a CO2 laser, which is quick and usually involves minimal bleeding.
3. Exercises and therapy. Stretches during healing help prevent the tissue from reattaching. Speech therapy then teaches the tongue to use its new range to produce sounds correctly.

Many specialists also recommend exercises before the release, so the child already knows the movements and the tongue muscles are ready. Your provider will tell you what fits your child's age and needs.

When to see a specialist

It's worth getting an evaluation if:

• Your child is past the age when a sound usually develops and still can't make it
• A teacher, pediatrician or SLP has raised a concern about the tongue
• Speech errors have lasted for months without improving
• Your child gets frustrated because others don't understand them
• There are other signs of restriction, such as feeding or sleep issues

You don't have to choose between a dentist and a speech therapist. Starting with either is fine, as long as both perspectives are part of the decision.

Frequently asked questions

Can a tongue tie cause a lisp?

It can contribute to one in some children. Sounds like s and z need precise control of the tongue tip, and a restricted tongue may push the sound forward or to the side. But lisps are common in young children with no tongue tie at all, and many outgrow them. An SLP can tell you whether the lisp is typical for your child's age or linked to how the tongue moves.

At what age can speech problems from a tongue tie be noticed?

Speech-related signs usually become noticeable between about ages 3 and 5, when children are expected to produce more sounds clearly. Before that, many sound errors are a normal part of development. If your child had feeding trouble as a baby, or you can see the tongue is restricted, you don't need to wait for speech problems to have it evaluated.

Will my child need speech therapy after a release?

Often, yes, if speech was the reason for the release. Freeing the tongue gives it the range of motion it needs, but your child still has to learn how to use that range for each sound. Some children improve quickly with a few sessions; others need longer. The SLP will set goals based on which sounds are affected and how your child responds.

Can a tongue tie cause a speech delay?

A tongue tie is not considered a cause of a true language delay, such as late talking, a small vocabulary or difficulty forming sentences. It can affect how clearly certain sounds come out, which may make a child harder to understand. If your child is talking less than expected for their age, start with an SLP evaluation and a hearing check.

Should I see a speech therapist or a dentist first?

Either is a reasonable starting point. If your main concern is how your child talks, an SLP can assess speech and refer you for a tongue evaluation if needed. If you can see the tongue looks restricted, or there are feeding or sleep concerns too, a dentist experienced with tongue ties can assess the tongue first. The best decisions come from both perspectives.

Talk to a Walnut Creek tongue tie specialist

If you suspect a tongue tie is affecting how your child speaks, a careful evaluation is the right first step. Our team can assess tongue movement and explain whether a release makes sense for your child or not. Learn more about tongue tie release for children at our Walnut Creek office.

Tooth + Tongue Specialized Dentistry and Anesthesia
1800 San Miguel Dr, Walnut Creek, CA 94596
(925) 949-8427