Laura posted on her concerns regarding parents being told that their child
will have speech problems.  Of *course* there is no certainty. But there are
no guarantees that there won't be problems, either.  Two points:

I had a mom with a newborn with breastfeeding problems. He had a clear
anterior tie and the recommendation was easy to make. I accompanied them to
the treating pediatrician and photographed the procedure. I remember
distinctly afterwards asking the mom what differences she felt on first
latch, and she said "it's better." Not it's great, but better. I remember
being a little disappointed and worried that I had represented the potential
improvement too highly.  They went on to breastfeed uneventfully for a year.
But when the little guy was 16 mos, she called me and said that she was sure
he was still tongue-tied and that he was trying to talk and was becoming
very frustrated. The ped didn't know what to say so I asked her to come back
and let me take a look. Well, you could clearly see the tongue being held
down. When I went back to my old photos, it then became clear to me that
there was a whole submucousal portion that we had not recognized as still
being present after the clipping of the anterior web. Tongue elevation was
terrible and speech was affected. I made an immediate recommendation for a
follow-up with an ENT.

My sister had fraternal twins four years ago, and lots of breastfeeding
pain. Both babies appeared to have posterior tongue restriction, but because
it was not super obvious and she didn't live in my area, I didn't press it.
Feeding pain persisted for 6 mos and longer. Now the twins are 4 and one has
perfectly fine tongue mobility and speech, but the little boy has already
had speech therapy. When I ask him to lift his tongue and demonstrate the
action to him, he stares at me with a blank, puzzled expression because he
cannot fathom the action of lifting his tongue. How I wish now that I would
have been more confident to recommend treatment, because now dad is
resistant to the idea.  I could not have predicted at the time that one
would end up with speech concerns and the other not, but I do know that my
sister suffered for a long time.

When I developed a handout for parents a few years back, I asked a dentist,
an orthodontist and an ENT to review it and allow me to publish their
endorsement of what I wrote so that when docs inevitably saw it, they would
not think that I was a lone ranger on this issue. I also wanted to get a
speech therapist and called my local elementary school to talk to their SP.
I asked her how often she saw tongue-tie in children with speech issues, and
she responded, "almost never."  I was shocked. I have had countless families
in my office with tongue mobility restricted babies and I'm watching and
listening to the parents talk and seeing a tongue that does not lift,
hearing subtle or not so subtle speech problems. I hear about the siblings
in speech therapy, the brothers and uncles and cousins (more often boys than
girls) who can't roll  their r's, who were in therapy, who had problems, and
who often also could not breastfeeding successfully. Just this past month I
had a mom with serious speech problems despite years of therapy; her brother
had the same speech problems but improved more than she did. Of course mom's
tongue did not have full mobility, and I am certain, given the genetics,
that neither did the brother's.   I considered how many of these children
and people have passed through the system with the etiology of their feeding
and speech problems never identified. It became clear to me that the SP
profession in general was not much higher on the ankyloglossia learning
curve than the pediatricians, and thus likely reinforced each other's
opinions on the topic.  It was an eye-opening moment.

I constantly wrestle with what to tell each parent when baby's sucking
appears to be impaired by restricted tongue mobility.  All I can do is talk
about probabilities without any guarantees. Do we play it conservatively and
wait to see if they fail? Do we advocate treating to eliminate the possible
risks? I wish I had a crystal ball to predict how many of these little
tongues will grow out and develop sufficient flexibility and how many never
will.  I'm still looking to pin down the key findings that may help with
this. Meanwhile, we roll the dice daily on which moms will hang in there and
which just can't continue in the battle. I look forward to the day that we
have knowledgeable cross-disciplinary support to help make decisions. 

Lisa Marasco

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