There's a converse to the neuronal connection issue: we could be 
cementing a lack of mobility by not intervening early enough also. 
There's a lot of neuronal pruning in the first 3 months of life, with 
only connections that are working becoming established and maintained. 
If the tongue is physically restricted by an abnormally short, anterior 
or inelastic frenulum, might we be reducing the representation of the 
tongue in the motor cortex if we don't treat before 3 months? This is 
only speculation, though we do see faster and more spontaneous 
improvement of sucking skills in babies who have frenotomies earlier 
than 12-16 weeks rather than later, and better improvement in infants 
than adults. More extensive speech therapy is generally required the 
older the patient.

If we use good pain relief during and after the procedure, there's less 
risk of adverse neurological consequences.

I agree that we have very little research on any of this, this is why 
the IATP was created, to help generate good studies. It is so important 
that we all share what we know (and don't know) from our varied 
education and experience so we can identify areas that need to be 
studied and provide the best care for our clients in the meantime.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 4/2/2011 3:04 AM, Laura Wasielewski wrote:
> Hello Brilliant Women (and men),
>
> I've been reading this latest tongue tie thread with great interest and with the recent comments about speech I have to finally chime in. As someone who married into a family with lots of tongue ties and now is the mother of a tongue tied (non-clipped) nursing toddler, ankyloglossia has always been of particular interest to me, even before I became an IBCLC or started working with babies. My husband and I started dating in high school, well before I started my SLP course work and finally learned the formal name (ankyloglossia) for what was up with my boyfriend's funny tongue. To my knowledge there are no large sample formal studies in peer reviewed journals on the incidence of speech or articulation disorders in individuals with tongue tie. I have certainly looked. Please correct me if I am wrong. I have seen one study (in Polish!) that stated individuals with tongue tie produced certain sounds with different tongue placement than non-tongue tied individuals, but the speech productions "sounded" correct. This is certainly the case for my husband, his mother and other family members. Hubby's type 1-2 tongue tie prevents him from lifting his tongue tip to his alveolar ridge to produce the "s" sound in the same placement that I use but he sounds just like me nonetheless. There are also a couple of small studies that showed improved speech in some children after frenotomy (Messner&  Lalakea, 2002).
>
> I do take issue with *any* type health care practitioner telling parents that their child will have speech problems if the frenulum is not clipped. In my opinion the evidence is just not there, at least not yet. In my particular graduate program in the US we were taught to always look for a tongue tie and note it in our oral motor assessment, but in the same breath we were told it is typically not a problem for accurate speech production. (Again, I don't think the evidence is really there to support the statement that tongue tie isn't a problem for accurate speech production either!) In my personal experience the only children that I worked with that had articulation disorders as well as tongue tie were those who also had some sort of cognitive deficit, ranging from severe mental retardation to very mild learning difficulties. I have wondered if their cognitive deficits made it more difficult for them to compensate for their anatomy? But I do realize that this only my very limited perspective and it was (seemingly a lifetime) before I started working with moms and babies.
>
> There is certainly a very long list of things that *might* be an issue in the future for a baby with a tongue tie but it just all seems very ambiguous to me. Correlation doesn't infer causation necessarily. For example, my husband does not have the vast majority of the wide array of problems that could be associated with tongue tie but he did have orthodontia. Would he still have needed orthodontia if he had been breastfed? (Not being breastfed was unrelated to the tongue tie!) Or would the degree of orthodontic intervention needed have been less if he had been breastfed? I have to wonder... (Our 18 month old son already has better lingual mobility than his dad in spite of a nearly identical tongue tie.) And furthermore almost everyone I know around my age had braces. They are certainly not all tongue tied. Once again, I'm trying to make sense of things from my very limited perspective.
>
> I think it is important to *try* to take as broad of a view as possible of the situation as a whole and also of each tongue tied baby and his mama that we work with. I think we're in very dangerous territory when we become dogmatic or insistent about any issue, particularly those that we do not fully understand and that there is not a wide body of credible evidence to support. There is SO much research that needs to be done in the area of ankyloglossia!
>
> So how do we broaden our perspective? Besides reading lactnet;-) I loved the experiences someone (Jeanette???) mentioned of seeing greatly different frequency of tongue tie in different locations and populations. It does make sense that certain gene pools would have more of this anomaly than others. Look at your population. Then look at the individuals and families you're working with. When a baby has a restrictive frenulum I like to ask the parents if I can look in their mouths too. Do they have it? If so, did they have speech problems? Orthodontia history? Sleep apnea? Reflux? Did the tongue tied dad's mother nurse him? Why not? Etc... Obviously if your parent says yes to any of the above I would think the child is certainly at greater risk of having that problem as well. And of course look at mom's anatomy too. We all know that a mom with true inverted nipples and a tongue tied baby is much more likely to have trouble than a mom with everted, elastic nipples. Look at your resources, do you have a go to person for clipping or is it a total nightmare to try to get it done in your area? Messner's research (2000) looked at 1000+ babies and said that after 6 weeks only 25% of babies with tongue ties continued to have latch problems/cause nipple pain. Can/will the mom you're working with hang in there for six weeks? Or is it worth it to fight the good fight for her with the local practitioners to get it clipped ASAP? How much pain is mom in? What do her nipples look like?
>
> One more personal bias, I have a very hard time believing that having a tongue tie clipped is not painful and/or traumatic for at least some babies. I have seen the procedure performed a couple of times. I am a firm believer in the wealth of research that early experiences hard-wire us neurologically. (Go hear Nils Bergman speak sometime!) I am very hesitant to expose a baby to something that I think might create negative neuronal connections. Though I do realize a tongue tie clipping is probably a walk in the park compared to the average American over-medicated, over-managed hospital birth. Yuck! That is a separate very sad story though...
>
> I guess I'm saying that there are no easy answers and I think it's grossly oversimplifying a very complicated situation to say that all tongue ties need to be clipped or that conversely, as some MD's seem to believe, no tongue ties need to be clipped.
>
> I do tremendously appreciate this forum where we can all discuss these issues and our experiences and learn from each other.
>
> -Laura Wasielewski MS, CCC-SLP, IBCLC
> Speech Language Pathologist
> Board Certified Lactation Consultant
> Wife of a tongue tied husband
> Mother of a tongue tied nursing toddler
> :-)
>
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