Tongue-Tie, Lip-Tie and Your Child’s Speech

The honest answer first: a tongue-tie rarely causes a speech problem on its own. Most children with a tongue-tie or a lip-tie go on to talk perfectly clearly and never need anything done about it. Ties matter far more for feeding in the early months than they do for speech later. Where a tongue-tie does affect speech, it usually shows up in a small group of tongue-tip sounds — not in whether a child talks at all.

Parents ask us about this almost every week — usually after a hard few weeks of feeding, or after a relative noticed something under the baby’s tongue. Below: what a tongue-tie and a lip-tie actually are, which sounds a tie can touch, what we look at in a speech and language therapy assessment, and when a release is genuinely worth discussing with a doctor or dentist.

What is a tongue-tie?

A tongue-tie, or ankyloglossia, is when the small band of tissue under the tongue — the frenulum — is short, tight or attached unusually far forward, so the tongue cannot lift, stretch or move sideways as freely as usual. It is there from birth. Some ties clearly restrict movement; many are mild and get in the way of nothing at all.

A tie is a variation in anatomy, not an illness. That is why the useful question is never “is there a tie?” but “is this tie stopping my child doing something they need to do?” — feeding as a baby, or speaking clearly as a toddler.

“Bachay ki zaban bandhi hui hai” — what families in Multan tell us

Parents usually describe this to us in Urdu as زبان کی لگام (zaban ki lagaam), or simply say bachay ki zaban bandhi hui hai or zaban chhoti hai. One thing we say plainly to every family: if anyone offers to snip the frenulum outside a proper medical setting, please say no. If a release is ever needed at all, it belongs with a doctor or dentist who has examined your child.

What is a lip-tie?

A lip-tie is the same idea in a different place: the band joining the upper lip to the gum above the front teeth is thick or tight enough to stop the top lip lifting and flanging freely. Like tongue-tie it is present from birth and is usually noticed during feeding. Its link to speech is weaker still, because the lip sounds — “p”, “b” and “m” — rarely depend on that band.

Where a lip-tie can matter is comfort at the breast or bottle, and keeping the upper front teeth clean as they come through — both worth raising with your dentist at a routine check.

Does a tongue-tie actually cause speech problems?

Usually not. The tongue is remarkably adaptable, and very many children with a tongue-tie produce every sound clearly with no treatment of any kind. A tie does not stop a child learning words, understanding you, or putting sentences together. Where a restrictive tie does have an effect, it is on the clarity of a few sounds — not on how much your child talks.

Two things follow from that, and both save families a lot of worry. First, a tie almost never explains a child who is not talking yet. Late talking is about words, understanding and back-and-forth communication, and it needs a different look altogether — our guide to when a speech delay is a concern walks through that, and speech delay explains what we assess.

Second, unclear speech has several more likely explanations than a tie: perfectly ordinary immature sound patterns for the age, an articulation difficulty, fluid in the ears or another hearing problem that muffles what your child hears, or a habit that keeps something in the mouth for hours — our piece on whether a dummy affects speech is worth a look.

Which speech sounds can a tongue-tie affect?

The sounds most likely to be affected are the ones that need the tongue tip to lift to the ridge behind the top teeth or push forward: “t”, “d”, “n”, “l”, “s”, “z”, “th” and “r”. Sounds made at the back of the mouth, like “k” and “g”, and sounds made with the lips, like “p”, “b” and “m”, are rarely affected. Even with restricted movement, many children produce all of these clearly by finding another way.

Age matters as much as anatomy. Several of those sounds are still settling in through the preschool years, so a fuzzy “s” at three or a wobbly “r” at five is often just a sound that has not arrived yet. Check the sound that worries you against our chart of speech sounds by age first.

What signs are worth checking?

None of these means a tie is definitely causing trouble. Together, they are a fair reason to have someone look properly:

• Your child cannot poke the tongue past the lips, or cannot lift the tip to touch behind the top teeth with the mouth open wide.
• The tongue looks heart-shaped or notched at the tip when they stretch it out.
• The upper lip is hard to flange out, or a thick band sits between the top front teeth.
• Feeding was difficult in the baby days — a shallow latch, pain, clicking, long feeds, slow weight gain.
• A small, specific cluster of sounds is unclear, rather than talking being behind across the board.
• The tongue tires quickly or speech gets noticeably less clear at the end of a long sentence.

How can I look at my child’s tongue at home?

Sit facing a window or a lamp and make it a copying game, not an examination. Ask your child to poke the tongue out past the lips, then to open wide and touch the tip behind the top teeth, then to sweep it cheek to cheek. Watch how far it reaches, and whether the tip pulls into a heart shape. This is a look, not a diagnosis.

What happens at an assessment with us?

We start from your child, not from the tie. Mahnoor Baloch, our Speech & Language Therapist, takes the feeding and talking history first — how the early weeks went, when words started, what has changed. Then she watches the tongue and lips move in play rather than on command, listens to real speech in real sentences, and checks understanding and vocabulary alongside clarity.

The finding that changes everything is whether the sound errors match the movement limits. A child whose tongue barely lifts but whose “t”, “d” and “s” are crisp does not have a speech problem caused by a tie. A child whose tongue-tip sounds are all distorted, whose tongue genuinely cannot reach the ridge, and whose early feeding was hard, is a different picture — and that is the child we would want a doctor or dentist to see alongside us.

We also say plainly what is not ours to do. If a baby is struggling to feed or gain weight, that needs a doctor or a feeding and swallowing specialist first — we do not run a medical feeding and swallowing service, though we do support the everyday eating and mealtime side of feeding difficulties. If hearing is in any doubt, we ask for a hearing test before we draw conclusions about sounds. And any decision about a release belongs with a medical or dental clinician.

Does my child need surgery for a tongue-tie?

Often, no. The first step is an assessment, never a procedure. A release, called a frenotomy or frenectomy, is a decision for you together with a doctor or dentist, and it is considered most often for feeding difficulty in babies. For speech, the case is far less clear-cut: releasing a frenulum does not by itself teach a child to make a sound. Practice does that.

If a release is suggested, these are fair questions to ask the clinician offering it: what exactly is restricted, and how did you measure it? What do you expect to change? What happens if we wait six months? What aftercare or stretching is involved, and who follows up? Is speech therapy needed either way? Nobody should feel rushed into cutting anything on the strength of a photo sent over WhatsApp, and it cannot be undone.

What can I do at home tomorrow morning?

• Say the word back properly, once, and move on. If they say “tar”, you say “yes, a big red car”. No “say it again”, no correcting — that turns talking into a test.
• Get face to face. Sit at their eye level so they can watch your tongue and lips do the work. Children learn sounds by seeing as well as hearing.
• Play silly mirror games — licking yoghurt off the top lip, moving a raisin from cheek to cheek, blowing bubbles. These build awareness and are fun; on their own they are not a substitute for practising real sounds in real words.
• Count words, not clarity. If your child is picking up new words every week, the engine is running — clarity usually follows.
• Cut dummy time to sleep only, if a dummy is still around during the day.
• Keep both languages. Urdu, Saraiki, Punjabi and English at home is not a cause of unclear speech, and dropping one does not help.

When should we see someone?

Book a check rather than waiting if a baby is feeding poorly or not gaining weight; if you or others often cannot understand your child; if talking is behind as well as unclear; if your child is frustrated or avoiding speaking; or if a procedure has been suggested and you want a second opinion first. Our list of signs your child may need speech therapy is a useful sense-check.

If a tongue-tie or lip-tie is on your mind — feeding, a few unclear sounds, or a comment that lodged itself and would not leave — let someone look properly before you worry further. We see families in Multan at MPS Road, Block A Model Town, and we guide parents elsewhere online. Get in touch with our team and we will tell you honestly what we see, including if the answer is that nothing needs doing at all.