I agree that we can't see what we don't ever look for. In my own 
personal experience, my tt'd firstborn had 7 different speech therapists 
over as many years, and every one of them wrote that his oral anatomy 
was normal for speech production. Not one ever looked under that tongue. 
We finally had a frenotomy performed when he was 10 and developed sleep 
apnea and his malocclusion became . Within 24 hours of the frenotomy, 
his speech was perfect. All those years of speech therapy couldn't work 
completely until the frenotomy.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 4/27/2011 10:15 PM, Lisa Marasco IBCLC wrote:
> 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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