My Child Has a Tongue Tie. Now What?
Your dentist says your child has a tongue tie.
Someone on social media says it needs to be released immediately.
Another provider says to leave it alone.
So… who’s right?
The answer is: it depends on what the tongue is actually doing.
A tongue tie, or ankyloglossia, is a restriction of the tissue underneath the tongue called the lingual frenulum. But simply seeing a frenulum—or even being told that it looks “tight”—doesn’t automatically mean your child needs treatment.
What matters most is function.
Can the tongue move the way it needs to? Is it affecting breathing, eating, swallowing, speech, oral rest posture, or other everyday activities?
Those are the questions that help determine what should happen next.
What Is a Tongue Tie?
Everyone has a band of tissue beneath the tongue called the lingual frenulum. In some people, that tissue restricts the tongue’s movement enough to interfere with function. This is commonly referred to as a tong
ue tie.
Tongue ties can look very different from one person to another. Some are easy to see when the tongue is lifted. Others may be less visually obvious. That is one reason appearance alone does not tell us everything we need to know. A child can have a noticeable frenulum and function very well. Another child may have more subtle-looking anatomy but demonstrate meaningful difficulty with tongue movement.
Does Every Tongue Tie Need to Be Released?
No.
There are two reasons this may be the case
1. Function is not impacted
Finding a tongue tie does not automatically mean a frenectomy or frenotomy is necessary. What matters most is not simply how the frenulum looks, but whether it is actually affecting function.
A child may have a very noticeable frenulum and function perfectly well. Another child may have a less obvious restriction but demonstrate meaningful difficulty with tongue movement.
That is why the more useful question is usually not:
“Does my child have a tongue tie?”
It is:
“Is my child’s tongue movement contributing to a functional problem?”
The tongue does not work in isolation. Breathing, lips, jaw, tongue posture, chewing, swallowing, speech, and oral habits can all influence one another.
A release is a procedure — not a diagnosis and not a complete treatment plan by itself. The goal should never be simply to make the tongue look “less tied.” The goal is to determine whether a restriction is interfering with everyday function and, if so, what combination of treatment may be most appropriate.
2. Orofacial Myofunctional Therapy may be enough to gain function
Depending on the child’s needs, orofacial myofunctional therapy may help improve tongue awareness, coordination, oral rest posture, swallowing patterns, and other functional skills. In some cases, therapy may help clarify whether a surgical release is actually necessary.
A team approach is recommended when determining the most appropriate treatment plan, particularly when a release is being considered.
What Signs Might Suggest a Functional Concern?
Not every child with one of these signs has a tongue tie, and not every tongue tie causes these symptoms. But they may be reasons to look more closely at oral function.
Possible concerns can include:
Difficulty lifting the tongue toward the roof of the mouth
Limited side-to-side tongue movement
Open-mouth resting posture
Frequent mouth breathing
Difficulty maintaining the tongue on the palate at rest
Eating challenges: difficulty moving food around the mouth, trouble licking an ice cream cone, licking the lips, or having messy or inefficient chewing.
Unusual swallowing patterns
Persistent tongue thrust
Certain speech sound difficulties, particularly when the child appears to use unusual tongue placement or compensatory jaw movements
Poor oral health due to inability to clear food debris.
Oral fatigue or excessive effort with some tasks
Difficulty with oral coordination
Compensatory jaw movements when trying to move the tongue
A child may also have several of these concerns for reasons completely unrelated to a tongue tie. That is why a thorough evaluation is important.
What Is Orofacial Myofunctional Therapy?
Orofacial myofunctional therapy, often shortened to OMT or myofunctional therapy, focuses on the way the muscles of the mouth, face, tongue, and jaw function together.
Depending on the individual, therapy may address skills such as:
Tongue resting posture
Lip closure
Nasal breathing
Tongue elevation
Tongue coordination
Chewing
Swallowing patterns
Oral awareness
Eliminating compensatory movements
Therapy should always be individualized. The goal is not to give every child the same list of tongue exercises. It is to identify what is interfering with function and develop the skills needed for those patterns to carry over into everyday life.
What About Speech?
This is where things can become confusing for families. A tongue tie does not automatically cause a speech disorder. Some children with restricted tongue movement have completely typical speech. Others may have difficulty with certain sounds or may compensate with the jaw or other parts of the mouth.
Speech should therefore be evaluated functionally, rather than assuming the tongue tie is responsible simply because it is present.
If a child has speech concerns, the evaluation should look at both:
Which sounds are difficult
Whether tongue mobility is actually limiting the movements needed to produce them
Sometimes speech therapy with a speech-language pathologist alone is appropriate.
Sometimes myofunctional therapy may also be helpful to address the structural issues and make speech therapy more effective.
And sometimes the tongue tie has very little to do with the child's speech difficulties at all.
Why Might Therapy Be Recommended Before a Tongue-Tie Release?
For some children, therapy before a release can be helpful. If the tongue has been restricted for years, the child may have developed compensatory patterns for eating, swallowing, resting, or speaking.
Simply releasing the tissue does not automatically teach the tongue what to do differently.
Pre-release therapy may focus on:
Improving awareness of tongue movement
Teaching tongue elevation and coordination
Identifying compensatory jaw movements
Establishing appropriate oral rest posture
Preparing the child for post-procedure exercises or movement
It can also provide valuable information.
If a child cannot perform certain movements because of poor coordination rather than a true structural restriction, that may influence whether a release is appropriate.
Why Might Therapy Be Needed After a Release?
There are two very important reasons for post-release OMT. There are two important reasons OMT may be recommended after a tongue-tie release:
1. Learning to use the new range of motion
A frenectomy changes the structure, but it does not automatically change years of movement patterns. A child may still need to learn where the tongue should rest, how to elevate it without moving the jaw, and how to incorporate that new movement into swallowing, eating, and speech.
2. Supporting healing and maintaining movement
After the procedure, therapy may include activities designed to encourage appropriate tongue mobility and coordination as the area heals. The treating provider will also give specific post-operative instructions based on the procedure performed.
This is especially important when a child has spent years compensating for restricted movement. The goal is not simply greater mobility. It is functional use of that mobility.
What Happens During an Orofacial Myofunctional Evaluation?
An evaluation looks at much more than whether a frenulum is present. A parent interview is an important part of the assessment. As a clinician, I am going to want to know about medical and developmental history, oral habits, and how your child performs many routine activities. The child will be asked to imitate certain movements with their mouth, and photos may be taken of the mouth, face, and posture for clinical reference and progress monitoring. They will also have time to talk, eat a snack, and drink. The evaluation helps determine whether myofunctional therapy may be appropriate and whether another provider should also be involved.
Who Else May Be Part of the Care Team?
Tongue-tie care is often interdisciplinary, with each professional bringing a different perspective. Depending on the concerns, the team may include:
Speech-language pathologist
Orofacial myofunctional therapist
Pediatric dentist
General dentist
Orthodontist
ENT
Pediatrician
Lactation consultant for infants
Other medical or dental specialists
Can Orofacial Myofunctional Therapy Be Done Virtually?
In many cases, yes.
Orofacial myofunctional therapy can often be completed successfully through teletherapy, particularly for children around age 5 and older.
Age alone, however, does not determine whether virtual therapy will be a good fit.
A child typically needs to be able to:
Attend to the screen
Follow directions
Imitate oral movements
Participate in structured activities
Practice between sessions
Accept caregiver support when needed
Some five-year-olds do beautifully virtually.
Some older children need more hands-on support.
The best format depends on the child's attention, communication skills, ability to follow instructions, and the specific concerns being addressed. For the right child, virtual therapy can be convenient and effective—especially because much of myofunctional therapy involves observation, instruction, practice, and home carryover.
So… What Should I Do Next?
If your child has been told they have a tongue tie, you do not have to rush into a decision.
Start by asking:
What functional problem are we trying to solve?
Is the tongue restriction actually contributing to that problem?
Are there other possible causes?
Would therapy be helpful before making a decision about release?
Who should be involved in the evaluation?
The goal should be to understand your child's individual function, rather than treating the appearance of a frenulum.
Orofacial Myofunctional Therapy in Savannah, Georgia
As a speech-language pathologist with additional training in orofacial myofunctional therapy, I look at speech, oral movement, breathing, feeding, swallowing, and related oral patterns together rather than viewing the tongue in isolation. Savannah Speech Therapy provides orofacial myofunctional evaluations and therapy in Savannah, Georgia, with virtual services available for appropriate children and adults throughout Georgia.
If you have questions or would like to get started, complete the contact form, call 912-712-2292, or email hello@savannahspeechtherapy.com.
