Tongue Tie and Late Talking

A tongue tie is a short or tight band of tissue under the tongue that limits how the tongue moves. According to the American Academy of Pediatrics, tongue tie will not delay speech development, and where it plays any part in speech, it concerns how certain sounds are formed rather than how many words a child uses.

What you’ll learn

• What a tongue tie is, and what releasing one involves
• Why the number of words and the clarity of sounds are separate questions
• What the evidence on release does and does not show
• Who to see first when a child is talking late

Is a Tongue Tie Why My Child Isn’t Talking?

The American Academy of Pediatrics (AAP), in its information for parents, states plainly that a tongue tie will not delay a child’s speech development. In a consensus statement from the American Academy of Otolaryngology-Head and Neck Surgery, a panel of pediatric otolaryngologists, the ear, nose and throat surgeons who treat children, agreed that tongue tie does not usually affect speech.

The panel’s reasoning comes down to how the tongue moves. Even the sounds that need the most tongue lift, l and r, and the sound that needs the tongue pushed forward, th, can usually be made when the tip of the tongue is significantly restricted. The American Speech-Language-Hearing Association (ASHA) describes the research on how tongue tie affects newborn feeding and later speech as conflicting, but trending toward little or no effect on either.

These statements carry different kinds of weight, and the surgeons’ statement is a consensus of expert opinion, reached over three rounds of surveys, not the result of a trial. Even so, on whether tongue tie affects speech, the AAP, the surgeons’ panel and ASHA all point in the same direction.

What a Tongue Tie Is, and What Release Involves

The surgeons’ statement defines tongue tie, medically called ankyloglossia, as limited movement of the tongue caused by a restrictive lingual frenulum, the band of tissue under the tongue. The AAP describes that band, which connects the tongue to the floor of the mouth, as unusually short or tight and present from birth, and estimates that 4 to 10 percent of newborns have a tongue tie.

Releasing a tongue tie takes one of two forms. A frenotomy, also called a frenulotomy and the usual procedure in infants, is a simple cut of the frenulum, while a frenuloplasty cuts the frenulum and rearranges the tissue.

Words and Speech Sounds Are Separate Questions

Speech and language are different things, and ASHA treats them as separate areas. Speech means making the sounds, while language means understanding words and putting them to use. A late talker’s difficulty is with language, meaning how many words the child uses, which is a different question from how clearly the child makes sounds, and both belong to speech and language development as a whole.

Where tongue tie plays any part, the AAP and ASHA connect it with articulation, the way a child forms sounds. The AAP says that a child who cannot easily touch the tongue to the roof of the mouth may have trouble making t, d, n, l, s, z or r sounds. ASHA says tongue tie may occur alongside speech sound errors, but that the evidence on whether tongue tie, or releasing it, affects those errors is debated.

ASHA cites one 2023 study that found a statistically significant association between how severe a tongue tie was and the presence of speech sound disorders, meaning the two turned up together, which does not show that one caused the other. The surgeons’ statement notes that a few studies have suggested a link between tongue tie and articulation difficulties, but that those studies were of low quality. A child who finds particular sounds hard is a separate topic, covered in trouble saying certain sounds.

From clinical practice

Few words and a tongue tie, seen together, can look like cause and effect. Two different things sit inside that worry. One is how many words a child uses, which is language. The other is how clearly the child makes sounds, which is articulation.

Wherever tongue tie plays a role at all, the AAP and ASHA link it to articulation. A question about how many words a child uses therefore points toward language, hearing and understanding, and away from the tongue.

What the Evidence Says About Release and Speech

Studies of release and speech have not settled the question. The surgeons’ statement says studies of whether surgery improves speech problems have given conflicting results, and that speech studies have used small samples and lacked the usual safeguards of a fair test, such as comparison groups, random assignment and blinding.

A 2015 systematic review in the journal Pediatrics, which gathered the published studies on treating tongue tie for reasons other than breastfeeding, found two studies that followed groups of children and reported better articulation, and speech that was easier to understand, after treatment. The review still concluded that the data were insufficient to judge the effects of frenotomy on anything other than breastfeeding.

On using release to prevent speech problems later, the statements are more direct. The surgeons’ panel reached consensus that release is not needed in a baby with little or no restriction of tongue movement to prevent a future speech disorder. The AAP’s 2024 clinical report, which deals with breastfeeding in infants, concludes that frenotomy to prevent issues such as speech articulation problems in the future is not evidence based. The AAP’s parent information adds that early tongue tie surgery cannot prevent speech, dental or breathing issues later in life.

None of these bodies describes release as a way to help a late talker start talking, add words or speed up language, and whether a particular child should have a release is a decision for that child’s own doctors.

Where to Start When a Child Is Talking Late

For a toddler who is talking late, the AAP notes that a pediatrician may send the child for a hearing test and to a speech and language therapist, who looks at both what the child says and what the child understands. A speech evaluation for a late talker looks at hearing, understanding, expression and play as a whole, so a word count is only one part of it.

When the child is younger than three, the state’s early intervention program also accepts a call straight from a parent, with no referral from a pediatrician, and the evaluation is paid for publicly in every state. The whole route, from the first phone call to the visit itself, is set out in getting a speech evaluation for a young child, and what the term speech delay covers is explained in speech delay in children.

Who to Ask About a Tongue Tie and Sounds

When a tongue tie does affect how a child forms sounds, the AAP says a speech therapist can evaluate the child and suggest the best course of treatment, which may include speech therapy. The surgeons’ panel encourages a consultation with a speech pathologist before surgery in an older child who is having the procedure for speech concerns. The panel also agreed that families should be told about the options that do not involve surgery: watching over time, help from a lactation consultant, and a speech-language pathology consultation.

If a speech-language pathologist (SLP) examining a child’s mouth has concerns about how the frenulum is formed or how it works, ASHA says the SLP refers the child to a surgeon who has experience with the procedure. The decision about surgery then rests with the surgeon, not with the SLP.

Common Questions From Parents

What Is a Tongue Tie?

A tongue tie, or ankyloglossia, is when the lingual frenulum, the band beneath the tongue, is unusually short or tight and limits the tongue’s movement. It is present from birth, and the AAP puts the share of newborns with one at 4 to 10 percent.

Can a Tongue Tie Cause a Speech Delay?

The AAP says a tongue tie will not hold back speech development, and ASHA calls the research conflicting but leaning toward little or no effect. Where tongue tie plays any part, it concerns how some sounds are formed.

Will Releasing a Tongue Tie Help My Child Talk?

None of the AAP, ASHA or the surgeons’ panel describes release as a way to add words or speed up talking. The AAP calls frenotomy to prevent future articulation problems not evidence based, and a 2015 review found the data insufficient to judge effects beyond breastfeeding.

Can a Tongue Tie Affect How Some Sounds Are Made?

It might. The AAP says a child whose tongue cannot easily reach the roof of the mouth may find some sounds harder, among them t, d, n, l, s, z and r. ASHA calls the evidence on tongue tie and speech sound errors debated.

Who Should Look at a Tongue Tie?

For how sounds are made, the AAP points to a speech therapist, who can look at the child and recommend treatment. If a speech-language pathologist then has concerns about the frenulum itself, ASHA says the child is referred to a surgeon experienced with the procedure.

What Should I Do First If My Child Is Talking Late?

Arrange a speech-language evaluation that looks at hearing, understanding, words and play. Your pediatrician may check hearing and refer you to a speech and language therapist, and for a child under three, you can call your state’s early intervention program yourself, without a referral.

Reviewed by Monica d’Errico-Franklin, M.S., CCC-SLP

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