If you’ve ever been told your child might have a tongue-tie, you’ve probably also encountered a confusing mix of opinions — from “it’s no big deal” to “it needs to be treated immediately.” The reality is somewhere in between, and getting the right information from a knowledgeable provider makes all the difference.
Tongue-tie is a real condition that can impact feeding, speech, sleep, dental development, and more. It’s also frequently misunderstood — both overtreated and undertreated depending on who you ask. This guide gives you the facts you need to make an informed decision for your child.
What Is a Tongue-Tie?
A tongue-tie — medically called ankyloglossia — is a condition present at birth in which the frenulum (the small band of tissue connecting the underside of the tongue to the floor of the mouth) is abnormally tight or short. This restricts how far and how freely the tongue can move.
A person with a tongue-tie often has a tongue that appears short, notched at the tip, or heart-shaped when extended. But appearance alone doesn’t determine whether treatment is needed — function does. A tongue-tie should be evaluated and treated based on what it’s preventing the person from doing, not simply on how it looks.
There are also lip ties (connecting the upper or lower lip to the gum) and buccal ties (connecting the inner cheeks to the gum) that can cause similar functional challenges, particularly in infants.
What Areas Can Tongue-Tie Affect?
The tongue is involved in far more than most people realize — eating, speaking, breathing, and even sleeping all rely on appropriate tongue movement and resting posture. A restricted tongue can impact any of the following:
In infants and young children:
- Breastfeeding and bottle-feeding — difficulty latching, prolonged feeding sessions, poor weight gain
- Colic and excessive gassiness — often caused by swallowing air due to a poor latch
- Pain and discomfort for nursing mothers
- Aversions to certain food textures
- Hypersensitive gag reflex
- Frequent choking during feeding
In older children:
- Difficulty producing speech sounds clearly
- Reduced intelligibility in connected speech
- Speech placement errors (sounds produced in the wrong position)
- Tongue thrust (the tongue pushing forward against or between the teeth during swallowing)
- Poor dental hygiene — difficulty using the tongue to clear food from teeth
- Food pocketing in the cheeks (especially with lip or buccal ties)
- Mouth breathing instead of nasal breathing
Across ages:
- Tongue resting posture — ideally, the tongue rests on the roof of the mouth, not the floor; a restricted tongue can’t do this
- Dentition — tongue posture influences the shape of the palate and the alignment of teeth over time
- Sleep quality — tongue posture during sleep affects airway openness, which can contribute to snoring, restless sleep, or sleep-disordered breathing
- Headaches and jaw tension — teeth clenching and compensatory muscle patterns can result from tongue restriction
What Is Orofacial Myofunctional Therapy?
Orofacial myofunctional therapy (OMT) is a specialized program that retrains the muscles of the tongue, lips, and face to function correctly. It is provided by a speech-language pathologist with specialized training in orofacial myology.
OMT works through a combination of:
- Strengthening exercises — building the muscle tone and endurance of the tongue and other orofacial muscles
- Retraining techniques — teaching the tongue to rest in the correct position on the roof of the mouth, swallow without thrusting, and produce speech sounds accurately
- Habit elimination — addressing patterns like mouth breathing, thumb sucking, or prolonged pacifier use that can reinforce incorrect muscle patterns
Therapy is individualized — what it looks like for a five-year-old learning to swallow correctly looks very different from what it looks like for a teenager working on speech sounds or sleep-related concerns.
Common Areas Where OMT Helps
- Tongue resting posture — achieving a proper “tongue up” rest position on the palate.
- Nasal breathing — transitioning from mouth breathing to nasal breathing, which is healthier for the airway, sleep, and dental development.
- Tongue thrust — eliminating the forward push of the tongue during swallowing
- Speech sounds — correcting sounds affected by incorrect tongue placement or movement.t
- Snoring and sleep quality — improving airway openness through better tongue and lip muscle tone
- Dental outcomes — supporting better palate shape and tooth alignment over time
Orofacial myofunctional disorders are very common — and are especially prevalent in children who also have speech sound disorders.
What Is the Connection Between Tongue-Tie and Myofunctional Therapy?
When a tongue-tie restricts movement, the muscles of the tongue and face often compensate — developing incorrect patterns of movement over time. Even after a tongue-tie is released through a procedure called a frenectomy, those compensatory patterns don’t simply disappear. The muscles need to be retrained to use their new range of motion correctly.
This is why myofunctional therapy is typically recommended both before and after a frenectomy. Pre-procedure therapy helps maximize function before release and prepares the muscles for correct movement. Post-procedure therapy ensures that the new range of motion is used correctly and that compensatory habits are replaced with healthy ones.
A tongue-tie release without myofunctional therapy — or myofunctional therapy without addressing an underlying tongue-tie — often produces incomplete results. The best outcomes come from a coordinated team approach involving the SLP, the provider performing the release (typically a dentist, oral surgeon, or ENT), and sometimes other specialists like an occupational therapist or lactation consultant.
How Is a Tongue-Tie Evaluated?
Tongue-tie evaluation is not simply a matter of looking at the frenulum and measuring how far the tongue extends. A thorough evaluation assesses:
- The structure and movement of the tongue, lips, and cheeks
- Functional impact — feeding, speech, breathing, swallowing, and sleep
- Muscle tone and coordination
- Resting posture of the tongue and lips
Because every person’s anatomy is different, every evaluation — and every plan — looks different. A provider who tells you the frenulum “doesn’t look that bad” without assessing function is not giving you the full picture. Function is what matters.
Frequently Asked Questions
My baby’s pediatrician said tongue-tie rarely causes problems. Should I still get an evaluation? Tongue-ties exist on a spectrum, and their functional impact varies widely from person to person. If you are experiencing feeding difficulties, if your baby is not gaining weight appropriately, or if a lactation consultant has identified a latch issue, an evaluation from a provider who specializes in tongue-ties — such as a trained SLP or a dentist/ENT familiar with the functional assessment — is worth pursuing regardless of what the frenulum looks like visually.
At what age can tongue-tie be treated? Tongue-tie can be addressed at any age — from newborns to adults. In infants, treatment is often recommended early to support breastfeeding. In older children and adults, treatment is guided by functional impact and the presence of a myofunctional disorder.
Does my child need myofunctional therapy if they haven’t had a tongue-tie release? Yes, in many cases. Orofacial myofunctional disorders can exist independently of tongue-tie — from mouth breathing habits, extended pacifier or bottle use, thumb sucking, or simply underdeveloped muscle patterns. If your child is mouth breathing, has a tongue thrust, or is struggling with specific speech sounds related to tongue placement, OMT may be beneficial regardless of whether a tongue-tie is present.
How long does myofunctional therapy take? It depends on the child’s age, the nature of the disorder, and how consistently home exercises are practiced. Most programs range from a few months to about a year. Active participation between sessions — practicing exercises at home — is essential to progress.
Can a speech-language pathologist treat tongue-tie directly? SLPs do not perform frenectomies — that is a medical procedure performed by a dentist, oral surgeon, or ENT. However, SLPs with myofunctional training play a critical role in evaluating functional impact, guiding the decision about whether a release is appropriate, and providing the therapy that makes the release most effective.
How ETLC Can Help
If you’re concerned about your child’s tongue-tie, oral muscle function, speech sounds, feeding, or sleep — our team can help evaluate what’s going on and determine the right course of action.
Learn more about our Myofunctional Disorder services orschedule a free consultation to talk with a member of our team.
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About the Author
Sonia Strueby, M.A., CCC-SLP, is the founder of Enrichment Therapy & Learning Center. With over 25 years of experience as a speech-language pathologist, Sonia has dedicated her career to helping children overcome complex communication and academic challenges. She has advanced training and a special focus on treating dyslexia and childhood apraxia of speech, and she is passionate about providing families with a clear path to success.
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