TONGUE tie should not be associated with speech delay, says paediatrician Dr Lisa Kafula Nkole.
Dr Nkole says it is very common for parents to present their child to the hospital once they notice delayed or incoherent speech, asking medical staff to assess them for tongue tie (ankyloglossia) or surgical intervention.
She explained that before a child is born, a cord of tissue (frenulum) positioned in the centre of the mouth guides the development of the mouth.
“In early childhood, this cord continues to guide the position of new teeth and eventually thins out and becomes smaller as one grows. This is the thin structure we all see and feel below the tongue connecting the tongue to the floor of the mouth. Tongue tie (ankyloglossia) is a common name for a condition where this membrane (frenulum) under the tongue extends further than the usual position, more towards the tip of the tongue and sometimes affects the mobility of the tongue (forward and upward movements) in its most severe form. The tongue is one of the muscles involved in swallowing and speech and without free range of motion; it would be very difficult to do any of those activities,” she said.
Dr Nkole, who operates from the University Teaching Hospital, however said the severity of tongue tie varies among children hence the condition can be detected at any time in one’s life.
She said problems with tongue movement in a baby may affect breastfeeding such as poor attachment of the baby’s mouth to the mothers’ breast, leading to painful and bleeding nipples, frequent or prolonged feeding and poor weight gain.
“These may be the first signs of tongue tie. Other problems associated with tongue tie include problems with articulation of words, licking ice cream or lollipops and problems with playing certain wind instruments in future,” Dr Nkole said.
She said most children with tongue tie are well and have no symptoms.
“They learn to compensate for their tongue restrictions and lead normal lives with very few feeding and speech problems. A few children may have a severe form of tongue tie and might require minor surgery after complete evaluation by the medical staff. Some children with tongue tie may have a V-shaped notch at the tip of the tongue and are unable to stick out the tongue completely past the upper gums or touch the roof of their mouth with their tongue. They may also have problems in moving their tongue from side to side. These characteristics give an idea about how mobile the tongue is but measurement of the free tongue length is usually advised in determining how severe the tongue tie is,” Dr Nkole said.
She said surgery is usually reserved for severe and complete tongue tie while a ‘watch and wait’ approach can be adopted in most children.
Dr Nkole said even though most children will have no symptoms, a few children may present with severe problems with the way they produce sounds and words (articulation).
“It is often difficult to predict which children with tongue tie will proceed to develop speech problems or predict at a young age which child will eventually require treatment. That said, the progression of uncorrected tongue tie as it relates to speech is still a topic of debate. However, tongue tie is not associated with failure to develop or delay in speech development, but associated commonly with articulation problems in a child who has normal language development. Most children with tongue tie are able to interact normally and communicate with other people using gestures,” she said.
Dr Nkole said some parents believe that their child’s lack of speech, or speech delay, was due to tongue tie and present to the hospital requesting surgical intervention.
“Children with speech delay require a full assessment which may include hearing, speech/language, and neurodevelopmental assessments,” she said.
Dr Nkole said tongue tie, if indeed present, may be re-evaluated, and surgical correction considered, after the true cause of the speech delay has been determined.
She said when there was suspicion of tongue tie, parents and guardians should seek medical advice as cutting the frenulum at home by unqualified individuals with unsterile equipment may result in life-threatening complications.
“As noted earlier, problems with production of words may be a presenting feature of tongue tie in some children though commonly many children will have no speech problems. Children around the age of two to three years (when they are expanding their vocabulary and are usually very chatty) may have problems with articulation of certain sounds like “s, z, t, d, l, j, h, ch, th, dg” and it is especially difficult to roll an “r”. In consultation with a speech and language pathologist and medical practitioners, an assessment can be made on need of surgery to improve the speech ability of the affected child,” said Dr Nkole in an interview after a workshop organised by the Developmental Intervention Clinic to impart skills and knowledge to special education teachers and parents of children with communication, behaviour and cognitive challenges.
“Newborn babies with severe tongue tie that affects their feeding and growth may benefit from minor surgery after assessment by medical staff. Breastfeeding mothers who experience significant pain, bleeding nipples or those who notice that baby is having difficulties in latching on the breast and not growing appropriately, should have their babies evaluated at a health centre on breastfeeding technique and also tongue tie.”
The clinic is domiciled at the UTH Paediatric Centre of Excellence.