Few things in early childhood health have changed as fast as the conversation about tongue tie. Now it comes up at mothers' groups and kindy pick-up, and we're regularly asked whether a child's lisp, late words or fussy eating "might be a tongue tie." Sometimes it's a good question. Often the answer is less dramatic than the internet suggests.
One thing up front: speech pathologists assess how a child's mouth works for eating and talking. We don't diagnose a tongue tie as a medical condition, and we certainly don't cut anything.
What Tongue Tie Is (and Isn't)
Everyone has a lingual frenulum — the little band of tissue under the tongue that joins it to the floor of the mouth. In some children that band is short, tight or attached close to the tip, which can limit how far the tongue lifts, moves sideways or pokes forward. The medical term is ankyloglossia.
Here's the first myth to clear up: a visible frenulum isn't a tongue tie. The Australian Dental Association's multidisciplinary consensus statement, which Speech Pathology Australia helped write, is firm that frenulum appearance varies enormously and a diagnosis should never rest on looks alone (Australian Dental Association, 2020). What matters is function, and whether a real, observed problem is being caused by that restriction.
The Rise in Tongue Tie Surgery in Australia
Researchers using Medicare data found that frenotomy (division of the frenulum) in children under five rose from 1.22 per 1,000 children in 2006 to 6.35 per 1,000 in 2016, more than fivefold in a decade, with Queensland among the states with the sharpest rise (Kapoor et al., 2018). The authors noted that evidence for benefit had not kept pace with the rate of surgery.
That doesn't mean every release is unnecessary. But when clinics have added a feeding assessment before any surgical referral, the number of babies who went on to a procedure fell sharply: by about 60 per cent in one US hospital, and from 11 per cent to 3.5 per cent of newborns in a New Zealand region (Caloway et al., 2019; Dixon et al., 2018). The tongue ties didn't disappear. What changed was that a feeding assessment came first, and fewer babies went on to need a referral. That's a fair argument for careful assessment before any decision about treatment.
Where Tongue Tie Genuinely Matters: Feeding
The strongest evidence sits with breastfeeding. A tight frenulum can make it hard for a baby to latch deeply and hold a seal, showing up as a painful shallow latch, clicking during feeds, very long or very frequent feeds, or slow weight gain. Even here the research is more modest than many websites imply. A Cochrane review found frenotomy gave a short-term reduction in a mother's nipple pain but no consistent change in how well babies fed, and rated the evidence as low quality (O'Shea et al., 2017).
Tongue tie is sometimes blamed for toddlers' trouble with solids too. Occasionally there's a link; far more often the explanation lies elsewhere, and our article on fussy eaters versus problem feeders is a better place to start.
Some feeding signs should go straight to your GP, whatever the cause turns out to be:
- Coughing, gagging or choking during feeds, or a wet, gurgly voice afterwards
- Poor weight gain, or falling across percentile lines
- Refusing feeds, or feeds that regularly take longer than 40 minutes
- Frequent chest infections, which can point to milk or food going the wrong way
Where Tongue Tie Usually Doesn't Matter: Speech
This is the myth we meet most: that unclear speech will fix itself once the tie is released. The evidence doesn't support that.
How a frenulum looks tells you very little about whether it's getting in the way of speech. The Australian consensus statement puts it plainly: there's no evidence of a causative link between tongue tie and speech sound difficulties or delayed talking, particularly in children who never had feeding problems (Australian Dental Association, 2020). An expert panel of paediatric ENT surgeons reached the same conclusion, that tongue tie does not typically affect speech (Messner et al., 2020). A Curtin University study compared young children with treated ties, untreated ties and no tie at all, and found those with a tongue tie produced speech sounds in the same range as those without (Salt et al., 2020).
Where there is a possible effect, it's narrow: a severely restricted tongue might make a handful of sounds harder, such as the "l" in lolly. Even then, a release doesn't teach the tongue a new movement.
What drives most speech sound difficulties is how a child has stored the sound patterns of their language, not the shape of their mouth. If your child says "tat" for cat or leaves the ends off words, the useful question isn't "is it a tongue tie?" but "is this a phonological or an articulation pattern?" And if your toddler isn't saying many words yet, that's a language question (our late talkers article covers it), not a tongue question.
Who Should Be on the Team
Because tongue tie sits between several professions, the Australian consensus statement calls for inter-disciplinary care rather than one clinician deciding alone (Australian Dental Association, 2020). In practice that usually means:
- Your GP or paediatrician, who coordinates care and refers on
- A lactation consultant (IBCLC) or child health nurse, for breastfeeding assessment and the non-surgical strategies that are meant to come first
- An ENT surgeon, paediatric dentist or oral surgeon, who makes the medical diagnosis and carries out any release
- A speech pathologist, who assesses feeding, swallowing and speech function
Our role is to describe what the mouth is actually doing. We don't diagnose ankyloglossia or perform the procedure, and we'd be wary of anyone who diagnoses and treats ties without the rest of the team involved.
What a Speech Pathology Assessment Looks Like
If a child comes to us with a tongue tie question, the assessment happens at home or at kindy and is fairly low-key. We take a careful history, from feeding as a newborn to how sounds and words have developed. We look at the mouth at rest, then in action: can the tongue lift to the roof of the mouth, poke past the lips, sweep side to side to clear food from the cheeks? We watch a snack and a drink if feeding is the concern, and collect data on speech sounds in words and conversation if talking is.
The report names the sounds or feeding skills that are and aren't affected and says honestly whether what we've seen looks like structure, learning or something else, so your GP or surgeon can decide with you, without pressure in either direction.
If you'd like a clear-eyed look at your child's feeding or speech before deciding anything, get in touch. Speaking Speech Pathology offers mobile speech pathology across Brisbane's south side and Logan, visiting homes and early learning centres, with video sessions by Zoom where that suits.
Ready for practical strategies? Read our companion article: Supporting Your Child After a Tongue Tie Release: What Comes Next
Alexandra Bouwmeester is a Senior Speech Pathologist (MSPA, CPSP), certified in Hanen's It Takes Two to Talk and trained in the SOS Approach to Feeding, with over 14 years' experience and a mum of two boys. She offers mobile speech pathology to families across Brisbane's south side and Logan.
This article is general information and not a substitute for individualised speech pathology assessment or therapy. If you have concerns about your child, please speak with a qualified speech pathologist.
References
- Australian Dental Association. (2020). Ankyloglossia and Oral Frena Consensus Statement (1st ed.). Australian Dental Association.
- Caloway, C., Hersh, C. J., Baars, R., Sally, S., Diercks, G., & Hartnick, C. J. (2019). Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. JAMA Otolaryngology–Head & Neck Surgery, 145(9), 817–822.
- Dixon, B., Gray, J., Elliot, N., Shand, B., & Lynn, A. (2018). A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study. International Journal of Pediatric Otorhinolaryngology, 113, 156–163.
- Kapoor, V., Douglas, P. S., Hill, P. S., Walsh, L. J., & Tennant, M. (2018). Frenotomy for tongue-tie in Australian children, 2006–2016: An increasing problem. Medical Journal of Australia, 208(2), 88–89.
- Messner, A. H., Walsh, J., Rosenfeld, R. M., Schwartz, S. R., Ishman, S. L., Baldassari, C., ... & Satterfield, L. (2020). Clinical consensus statement: Ankyloglossia in children. Otolaryngology–Head and Neck Surgery, 162(5), 597–611.
- O'Shea, J. E., Foster, J. P., O'Donnell, C. P. F., Breathnach, D., Jacobs, S. E., Todd, D. A., & Davis, P. G. (2017). Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews, 3, CD011065.
- Salt, H., Claessen, M., Johnston, T., & Smart, S. (2020). Speech production in young children with tongue-tie. International Journal of Pediatric Otorhinolaryngology, 134, 110035.
