Tongue Ties, Oral Motor Development & Speech Delays: What Every Parent Should Know

Your toddler has been in speech therapy for six months. They're making progress, but it's slow. Their speech-language pathologist is wonderful, and the exercises are consistent — but something still seems off. Maybe feeding has always been difficult too. Maybe they gag on certain textures, drool more than other kids their age, or breathe through their mouth at night.

Here's what every parent should know.

What Is a Tongue Tie?

A tongue tie — clinically called ankyloglossia — occurs when the lingual frenulum (the thin band of tissue connecting the underside of the tongue to the floor of the mouth) is too short, too thick, or too tight. This restricts the tongue's range of motion.³

One widely used grading system, Coryllos's, sorts tongue ties by where the frenulum attaches:⁴

• Type I (anterior): The frenulum attaches at or near the tip of the tongue. Often visible — the tongue may appear heart-shaped when the child tries to stick it out.
• Type II: The frenulum attaches slightly behind the tip. Still usually visible.
• Type III: The frenulum attaches at the middle of the tongue. Harder to see, often missed.
• Type IV (posterior): The frenulum attaches at the base of the tongue and is hidden beneath the mucous membrane. Often invisible on casual examination — found by feel rather than by sight.

Types III and IV are easy to miss on a quick look because they don't look like the "classic" tongue tie. How much the type matters is less clear: it has not been shown to predict how much trouble a baby has breastfeeding, and there is still no agreed definition or set of diagnostic criteria for tongue tie.⁴

Lip Ties and Buccal Ties

It's not just the tongue. The upper lip frenulum (connecting the lip to the gum above the front teeth) is sometimes described as a lip tie, and the tissue connecting the cheeks to the gums as a buccal (cheek) tie.

Lip-tie release is often paired with tongue-tie release, but the AAP's review found that releasing lip or cheek ties does not improve breastfeeding: these bands are not directly involved in latching or sucking.¹

How Tongue Ties Affect Oral Motor Development

The tongue is arguably the most important muscle in the oral motor system. It needs to elevate, lateralize (move side to side), protrude, and retract with precision for:

• Breastfeeding and bottle feeding in infancy
• Chewing and swallowing solid foods
• Speech sound production — particularly sounds requiring tongue elevation (L, N, T, D, S, Z, R) and tongue-tip precision
• Oral resting posture — the tongue should rest on the roof of the mouth (palate), which influences facial and jaw development⁵
• Airway maintenance — proper tongue posture supports nasal breathing and an open airway during sleep⁵

A tongue tie can restrict some of this movement. How much it affects any of these jobs varies from child to child, and outside breastfeeding the research on what release changes is thin.³

The Connection Between Tongue Ties and Speech Delays

Not every child with a tongue tie will have a speech delay, and not every speech delay is caused by a tongue tie. A tongue tie does not delay speech development, though it can affect how a child forms certain sounds,¹ and studies have not found a clear link between tongue tie and speech disorders.⁶ It is worth asking about when:

Specific Speech Sound Errors Persist

The sounds most likely to be affected are those that need the tongue tip lifted to the alveolar ridge (the bumpy area just behind the upper front teeth):¹

• L — "wamp" instead of "lamp"
• R — "wabbit" instead of "rabbit"
• T, D, N — produced with the tongue blade rather than the tip, creating a "mushy" quality
• S, Z — produced with tongue protrusion (interdental lisp) because the tongue can't stay behind the teeth⁵
• TH — may actually be easier for tongue-tied children because it requires protrusion rather than elevation

Errors like these have other causes too, so a speech-language pathologist first works out whether an error is developmental, a motor-planning problem, or muscle-based. If your child has been working on these sounds with limited progress despite consistent practice, ask whether tongue movement is part of the picture; when an SLP has concerns about the frenulum, they refer to a surgeon experienced with the procedure.⁵

The Jaw Does the Tongue's Job

Some children with restricted tongue movement compensate — using their jaw to do the tongue's job, recruiting lip muscles, or talking with a restricted mouth opening. Speech-language pathologists look for this, because imprecise articulation can come from not being able to move the tongue separately from the jaw, and from a habitual resting posture of the tongue and jaw that keeps getting in the way of new sounds.⁵

Feeding History Offers Clues

Speech and feeding share the same anatomy. If your child has a history of:

• Difficulty breastfeeding (poor latch, nipple pain for the nursing parent, poor weight gain)⁴
• Gagging on textured foods
• Pocketing food in the cheeks
• Difficulty moving food from side to side while chewing
• Messy eating that seems beyond age-appropriate norms
• A strong preference for soft or pureed foods past the expected age

...these feeding challenges may share a root cause with their speech difficulties — or they may not, because feeding problems have many causes. When an SLP sees a tongue tie affecting feeding, part of the job is working out the primary cause.⁵

When Tongue Ties Mimic or Worsen Sensory Processing Challenges

Here's where things get particularly interesting for the DrSensory community: some of the feeding and mouth behaviors that get labeled as sensory can have a motor side too, and a child can have both. An oral-motor assessment checks both: how the tongue, lips and jaw move, and how sensitive the mouth is to touch.⁵

Oral Sensory Aversion That's Actually Structural

A child who gags on new food textures might be labeled as having "oral sensory defensiveness." And they might genuinely have sensory sensitivities. But if a tongue tie is preventing them from adequately manipulating food in their mouth, the gagging isn't purely sensory — it's mechanical. The tongue literally can't move the food safely, and the gag reflex is doing its job.

Whether release helps in that case has not been well studied: outside breastfeeding, the evidence on feeding outcomes is too thin to draw conclusions.³ A feeding evaluation that looks at both the sensory and the motor side is the place to start.

Mouth Breathing and Sleep

Mouth breathing has several possible causes. Enlarged tonsils and adenoids, swollen nasal tissue and allergies can block the nose and lead to an open-mouth posture and mouth breathing; structural differences, tongue tie among them, can encourage the tongue to rest forward instead of on the palate.⁵ Why it matters:

• Sleep — obstructive sleep apnea in children is linked with behavior and attention problems, and treating it improves both⁷
• Teeth and bite — dental malocclusions are linked with tongue-thrust swallowing and other oral habits⁵

So if your child snores or breathes through their mouth at night, tell your pediatrician. For most children with sleep apnea the first treatment is removing the tonsils and adenoids,⁷ and there is no evidence that releasing a tongue tie prevents it.¹

Drooling, Oral Awareness, and Body Schema

Drooling and poor oral control past about age 4 is one of the signs speech-language pathologists look for in an oral-motor assessment.⁵ It is often put down to low oral awareness or sensory processing differences, and that can be true; lip seal and tongue movement are part of the picture too. Drooling has been reported in untreated tongue tie, but only case series without a comparison group have looked at whether release helps it,³ so an assessment that looks at oral awareness, lip seal and tongue movement together is the useful next step.

Frenectomy: What the Procedure Involves

Frenotomy, frenectomy and frenuloplasty are the procedures used to release a tongue tie. Whether to do one is a medical decision made case by case, and not every tongue tie needs releasing.⁵ From a holistic dentistry perspective, here's what families should know:

Laser Frenectomy vs. Traditional (Scissors or Scalpel)

In my practice, I use a CO2 or diode laser for frenectomies. Sterile scissors are the most common method, and the AAP's review found no evidence that a laser works better: both work equally well.¹ The reasons I prefer the laser:

• Minimal bleeding — the laser cauterizes as it cuts
• Precision — the laser allows a targeted release
• No sutures required in most cases

The procedure itself is brief, usually done in the office without general anesthesia, and takes just minutes.¹ For infants, it can be done chair-side with a topical anesthetic. For older children, local anesthesia is used.

What to Expect After

• A check of tongue range of motion right after the release
• Some soreness for a few days, which over-the-counter pain relief can ease; call if bleeding or pain persists, though long-term complications are rare¹
• Stretching exercises afterward are debated. The AAP does not recommend them for infants: they have not been shown to help recovery and may make babies pull back from nursing for a while.¹ If stretches are suggested for an older child, ask what they are for and how long to do them.
• Any change in speech or feeding comes gradually, through therapy over the following weeks and months; there is not enough evidence to say that release on its own improves speech³

The Critical Point: Release Alone Is Not Enough

This is where the collaboration model matters most. A frenectomy releases the restriction, but the child's muscles and motor patterns don't automatically know what to do with their new freedom. They've spent months or years compensating, and those compensatory patterns are deeply ingrained.⁵

Post-release therapy can include:

• Myofunctional therapy to retrain tongue resting posture, swallowing patterns, and nasal breathing — it may not suit children under about 4, because it relies on following directions and self-monitoring⁵
• Speech therapy to address sound production errors now that the tongue can physically reach the right positions
• Occupational therapy for feeding skills if oral motor challenges have affected eating

The OT/SLP + Holistic Dentist Collaboration Model

The best outcomes I've seen happen when the dental team and therapy team work together — not in silos. Here's how the collaborative model works in my practice:

Pre-Release

• SLP or OT identifies potential tongue tie during feeding or speech therapy
• Referral to a dentist or surgeon experienced with tongue-tie release for a functional assessment⁵
• Baseline evaluation — documenting current speech sounds, feeding skills, and oral motor function
• Pre-operative myofunctional exercises — beginning to wake up the tongue muscles before release

Release Day

• Frenectomy performed by the dentist
• Stretching protocol taught to parents
• Communication to therapy team — what was released, what to expect

Post-Release

• Therapy resumes within 1-2 weeks — targeting the sounds and feeding skills that were previously structurally blocked
• Myofunctional therapy continues for 2-3 months to establish new tongue resting posture and swallowing patterns
• Follow-up dental assessment at 2 weeks, 1 month, and 3 months to ensure adequate healing and no reattachment

What the Research Shows

Be wary of anyone who promises results. For breastfeeding, release reduces the nursing parent's nipple pain in the short term, but trials have not found a consistent improvement in the baby's feeding.⁸ For speech, feeding beyond infancy and social concerns, the evidence is insufficient to say whether release helps; the few comparative studies were all of poor quality.³ There is no evidence that release improves dental health or prevents sleep apnea.¹

What release does is remove a physical limit. Whether that limit is what is holding your child back is what the assessment and the therapy team are there to work out.

Signs Parents Should Look for at Each Stage

None of these signs on its own means a tongue tie. Each has other possible causes, and fewer than half of babies with physical signs of tongue tie have trouble nursing.¹ Treat them as reasons to ask for an assessment, not as a diagnosis.

Infants (0-12 Months)

• Difficulty latching or staying latched during breastfeeding⁴
• Poor weight gain⁴
• Nipple pain or damage for the nursing parent⁴
• Heart-shaped tongue tip⁴
• Inability to poke tongue past the lower gum line¹

Toddlers (1-3 Years)

• Difficulty with food textures — gagging, pocketing, refusing solids
• Open mouth resting posture⁵
• Snoring or mouth breathing during sleep⁵
• Messy eating that isn't improving with age

Preschool and School-Age (3-8 Years)

• Persistent speech sound errors (L, R, S, T, D, N)¹
• Speech therapy progress that plateaus
• Difficulty licking an ice cream cone, licking lips, or touching tongue to the roof of the mouth³
• Picky eating with texture aversions
• Drooling past about age 4⁵
• Mouth breathing or snoring
• Difficulty playing wind instruments³

Adolescents and Adults

• Persistent speech differences
• Difficulty French kissing (yes, this is a real and valid concern for teenagers)³

No one has followed untreated tongue ties over time well enough to say what happens to them: some clinicians hold that a short frenulum stretches with age and use, and there are no long-term studies to settle it either way.³ What you can judge is function now. If a tie limits something your child needs to do, that is worth an assessment at any age.

Tongue ties and speech delays: the bottom line

Tongue ties sit at the intersection of dentistry, speech therapy, occupational therapy, and neurodevelopment. They're structural, but what matters is function — whether a tie gets in the way of how a child eats or speaks.

If your child is in speech therapy with slow progress or has a history of feeding difficulties, an oral-motor assessment that includes the tongue is worth asking about; if your child snores or breathes through their mouth at night, raise that with your pediatrician as well. Look for a provider who:

• Performs a functional assessment, not just a visual check
• Explains the options, including scissors and laser, which work equally well¹
• Works collaboratively with your SLP, OT, and other providers
• Tells you when a tie does not need releasing, and is clear about what release can and cannot be expected to do⁵

The tongue is small, but it does a lot of work. A careful assessment is how you find out whether a tie is part of your child's story.