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Thread: Anyone have a child with speech issues due to tight frenulum?

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    emilyb00 is offline INCIIDer - A Community Creator
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    Default Anyone have a child with speech issues due to tight frenulum?

    My younger DS (almost 4) cannot touch his upper lip with his tongue. He has been in speech therapy through the school district for a year now and isn't making much progress. They are telling me that his frenulum is too tight and suggesting clipping it. Just wondering if anyone else has gone through this and what the outcome was, or if you decided against it, did the speech improve? Thanks!

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    NancyR is offline INCIIDer - A Community Creator
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    I was just going to post here so Restless could see your question!

    Hugs again! N

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    If they think his frenulum is too tight, by all means make an appt with an ENT right away (that is who performs such a surgery). If he really can't touch his upper lip with his tongue, indeed it sounds too tight. There's no reason not to get this taken care of if it needs it.

    One of my kids had a frenulectomy when he was 8 months old, in conjunction with a larger surgery that he was having (poor kiddo had kidney surgery, a circ and the tongue clipped all at the same time - sore everywhere!). The mouth heals quickly. He is still in speech therapy at 4.5, the most delayed of all my kids, but I can't imagine how much worse it would be if he hadn't had his tongue clipped - his frenulum went all the way to the tip of his tongue. I think the technical term is anklioglossia or something similar. He has no difficulty moving his tongue now.

    My other ds is 18 months old, and we had a consult with the ENT when he was around 9 months, when I realized his frenulum was a little tight. With him, the ENT said it could go either way, he was borderline. Because of the rehab requirements afterward, we opted to wait (I was getting ready to wean him, and nursing is one of the "tongue exercise" options for a baby). As it turns out, this ds has so far met the minimum number of words such that he doesn't need to get evaluated for speech therapy yet (halleluiah - all 3 of his older sibs have been in speech therapy). So, it seems that for the moment his tongue is not a problem. The ENT said that if we didn't do it before he turned one, we'd have to wait until he was 3, just as a matter of getting cooperation to do the rehab exercises.

    At 4 y.o., there would be exercises involved following the surgery to get him used to moving the muscle in a way he hasn't before, but the speech therapist he is seeing should be able to handle that. As an example, he'd hold some food or candy item on the roof of his mouth with his tongue, with his mouth closed. Then, he would drop his jaw - that's easier than getting his tongue to lift. Then he'd hold it like that for I'm not sure how long, and repeat. There are plenty of others.

    There is anesthesia involved for very young kids, but I don't know about 4 y.o. I'd assume so, but I'm not sure, really. It's a very quick procedure. Call the ENT for a consult!!! At 4 y.o., there's no reason to wait on something like this!!!

    -beth

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    Sorry to sound so emphatic, but if he can't touch his lip with his tongue, it would be too tight practically by definition, if you know what I mean. I'm trying to find a really good old link that describes these things exactly, but I can't find it just yet.

    And by ENT, I mean a pediatric ENT, not a regular one, and preferrably one associated with your local children's hospital. (and by the way, they all seem to know each other - there are only a few hundred pediatric ENTs nationally, and our new ENT knows our old ENT from another state, on a first name basis)

    Our ped told us that for a long while, docs had been conservative in clipping tongues (perhaps because years before that, they had been too clip-happy), but that new information suggests they haven't been clipping enough lately, and so apparently now the younger peds don't hesitate to refer to the ENT for consults on tongue clipping.

    The only risk of the procedure that I can think of, besides anesthesia if it is needed, would be the risk of clipping too much. So, sometimes they tend to clip too little - as with my one ds who had the frenulectomy as a baby, a year later the ENT who performed the surgery looked at him again and said it maybe could use a tiny bit more, and the ENT here in our new state agreed. But for now we (including the speech therapist) don't see a need, since he can move his tongue in the necessary ways. We may or may not re-evaluate that down the road. It sticks pretty far out of his mouth as it is LOL.
    Last edited by wapiti; 12-11-2007 at 04:05 PM.

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    Restless is offline INCIIDer - A Community Creator
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    Default My DS had tongue tie surgery at 2 1/2

    Quote Originally Posted by emilyb00
    My younger DS (almost 4) cannot touch his upper lip with his tongue. He has been in speech therapy through the school district for a year now and isn't making much progress. They are telling me that his frenulum is too tight and suggesting clipping it. Just wondering if anyone else has gone through this and what the outcome was, or if you decided against it, did the speech improve? Thanks!
    and it helped a lot. He also was dx'd w/ Apraxia, so it didn't totally solve his problems, but certainly got him going in the right direction.

    It was one of the best things we could of done for him, and I would urge you to find a Pediatric ENT to help you with this.

    Gotta run but will respond more fully later.

    BW

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    Restless is offline INCIIDer - A Community Creator
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    Default Ok, I'm back.

    I suspected DS had a tongue tie, but the pediatricians didn't seemed concerned at all. At 2 1/2 he started really getting frustrated by his inability to talk and communicate, and that's when I took him to a regular ENT and Pediatric ENT. Both told me DS was severely tongue tied and needed surgery - we opted to have the Pediatric ENT do it because his practice and staff were child centered (obviously). FWIW, when DS would try to stick out his tongue, his tongue resembled the top of a heart. DS also had an oral motor coordination problem, so he still had to learn how to move and control his tongue after surgery.

    Surgery was done outpatient in the hospital under general anestesia. He was totally fine, and never needed anything more than Children's Tylenol after the procedure, although I had something stronger if he needed it. He was up and driving his PowerWheels Pick Up Truck up and down our driveway when we got home while DH and I took turns sleeping (we had to leave our house at 4AM to get to the hospital by 5AM. Due to his age, he was the first surgery of the day. I was able to give him the medication that made him loopy, and DH went into the Operating Room where they put in under general (and then DH left).

    I would do this surgery again in a heartbeat, and would recommend anyone who's child is dealing with this as well as having speeech issues consider this surgery. Speech Therapy was automatically approved by our insurance after this surgery for about 3 months.

    The most interesting thing is that my DS wouldn't touch peanut butter before this surgery, and then practically lived on it for the entire year after the surgery.

    BW

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    Default I posted to you over on PAI, but (m)

    just wanted to add that my ds (age 8) didn't need to have general anaesthesia for the frenulectomy--an oral surgeon did it (albeit in conjunction with other work) with just an IV and fentanyl/versed to make him loopy and some local anaesthetic. While I'm glad we got it done, I'm not sure I could've justified putting him under general anaesthesia solely for that procedure (but then again, I'm a wimpy ICU nurse and general anaesthesia freaks me out...lol). The surgery itself healed very quickly, stitches were out within a week and Ben wouldn't take any pain meds except for the first day when I made him. He drank smoothies and soup the first two days and then was back on a mostly regular diet thereafter. I have absolutely no regrets about the procedure and would recommend it, but I would examine your options regarding general anaesthesia vs. conscious sedation if you are interested in that. Your ds's young age might play into that decision as well--my ds is very stoic and doesn't flinch at needles or the like, but not all kids are like that obviously. If it had been my 12-year old daughter, we might have had to put her under general anaesthesia...lol

    Hope this helps!

    Carla

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    Restless is offline INCIIDer - A Community Creator
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    Default Just some additional info after reading Carla's post

    We were not given a choice about general or local, and if we were, we would of still chosen general due to the monitoring issue and stress on DS - he was not cooperative with the exams, and there was no way he'd be when it mattered (when the cut was being done).

    My DS did not have stitches after surgery - Ped ENT used a laser.

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    emilyb00 is offline INCIIDer - A Community Creator
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    Default Thanks for all the info

    We checked and he has this big piece of skin attached under the tongue that definitely needs clipping. Here is the info our speech therapist gave me in case anyone else wants info on this.

    In regards to Grant's restricted frenulum: If at 4 the tongue is still relatively anchored then time and development have not intervened to help stretch it and he remains at risk for subsequent consequences. A restricted tongue tip can interfere with tip alveolar speech sounds. Kids can compensate, but they end up using the midtongue instead which results in anterior placement of the tongue and increased risk for dental maloclussion including an open bite. The tongue is also restricted from lateralizing to the posterior molars which is necessary for dental hygiene. It also interferes with kissing...which I am sure is not a primary concern at this time. A restricted frenulum can most definitly interfere with speech as well as feeding, and saliva management.

    It is a very simple in the office procedure. I recommended someone who specializes in soft tissues such as a ENT or periodondist. The recovery time is minimal. Speech retraining may stil be necessary.

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