Whether or not you decide to have your child’s tongue tie released, there can be long-term effects. Releasing a tie reduces the restriction. It provides the opportunity for the tongue to have improved range of motion ability. But just because the tongue can now move in new ways, does not mean it will. The tongue still has to learn to move in ways it could not before.
Learning new motor patterns does not necessarily happen automatically. The habit of keeping the tongue low in the mouth can be hard to break and it often takes work to change this. Having a tie released is only one small piece of the puzzle.
Tongue Tie and Body Tension
A tongue tie is a fascial restriction. Fascia is connective tissue that connects everything in our body. There is fascia that goes down the center of our body and connects from our tongue all the way down to our toes (called the deep front line).
If there is tightness in the fascia, there can be tightness throughout the body. A common long-term effect of tongue tie is to see tightness in the neck, shoulders, trunk, and legs.
The Impact of Body Tension From Tongue Tie
Due to this tension, babies with tongue tie are more at risk of having torticollis (tightness on one side of the neck causing a head-turning preference) and plagicoephaly (flat spots on the skull). You may also see asymmetrical motor skills (such as only rolling in one direction), frequent arching, or toe walking.
This tension impacts the inner body in addition to the outer body and therefore can impact the stomach and esophagus, leading to digestive issues such as reflux.
Body tension is a common cause of discomfort for babies and children. If your little one hates their car seat, you may want to explore if body tension is a possible reason and try to figure out why the tension is there.
Tongue Tie and Sleep
Babies and children with a history of tongue tie are notoriously more difficult sleepers. Now that you understand the relationship between tongue tie and body tension, it is easy to see how poor sleep can be a long-term effect of tongue tie. If your body feels tight and you’re uncomfortable as a result, how would you be able to relax and sleep soundly?
Children with tongue tie have a tendency to breathe through their mouth due to low tongue resting posture, weakness, and/or body tension. Mouth breathing is not ideal because it prevents proper air filtration. If the air is not properly filtered, the tonsils and adenoids (which are part of our lymphatic system) can become enlarged.
Enlarged tonsils and adenoids are one of the most common underlying causes of sleep apnea. These structures live in the airway, so if they become enlarged, the airway becomes smaller and it can become more difficult to breathe, especially when laying down during sleep.
The body will have a hard time resting if it is not able to breathe. The child may wake up frequently, essentially to keep themselves alive and breathing.
Signs of Sleep Apnea or Sleep Disordered Breathing
- Mouth open
- Pauses in breathing
- Sleeping in odd positions (such as with neck hyperextended)
- Not able to sleep on their back
- Frequent waking
- Grumpy or still seems tired upon waking
If your child shows signs of sleep disordered breathing, check out our free roadmap for parents on next steps.
Tongue Tie and Behavior
New evidence is surfacing that shows a connection between ADHD diagnosis and tongue tie. When children don’t sleep well, it is common for them to act hyperactive rather than lethargic like we do as adults (although acting sleepy is possible too). This is why being labeled as having ADHD is another long-term effect of tongue tie.
All children with suspected ADHD or with signs of poor concentration or hyperactivity should have their sleep and airway assessed. It may be possible to improve their behavior and attention by improving their airway and sleep.
Tongue Tie and Feeding Issues
If a child does not know how to properly use their tongue, it is no surprise that their eating can be impacted. They may have difficulty using their tongue to move food over to the side of their mouth in order to properly chew. They may also have difficulty moving food toward the back of the mouth in order to swallow.
It is very common for children with a history of tongue tie to avoid foods that are more difficult to chew. This often includes meats and vegetables. They may have a preference for softer, easier foods such as crackers, soft fruits, pasta, yogurt, and chicken nuggets.
They may also have difficulty using their tongue to clean food off of their lips, chewing with their mouth closed, or licking foods such as an ice cream cone.
Tongue Tie and Dentition
The tongue is what shapes the palate (roof of the mouth). Proper tongue placement is up at the palate. If you close your mouth, you should feel your tongue elevated and touching right behind your top front teeth.
When the tongue rests low in the mouth, the palate can become high and narrow. This can lead to less space for the child’s teeth, especially as they begin to get their adult teeth. Tongue tie can therefore lead to dental crowding. A long-term effect of tongue tie can be the need for braces or removal of teeth due to crowding.
In addition, if the child has difficulty moving their tongue, they will likely have difficulty cleaning their teeth after eating. We usually don’t even realize we do this, but after we eat we use our tongue to clean food off of our teeth. You probably only realize the importance of this skill if you have popcorn or celery stuck in your teeth! But it is something we do naturally all the time.
If a child is not able to clean food off of their teeth after eating, they are more at risk for decay and cavities.
Tongue Tie and Speech
Tongue tie does not cause delayed speech, but it can make saying certain sounds more challenging. Although many children do find a way to compensate, they may not be able to make the sound in the typical way. The sounds “d”, “l”, “t”, and “th” may be the most challenging.
There is much debate on whether speech issues are a long-term effect of tongue tie. Your child’s doctor (or even speech therapist!) may use this as a reason not to clip their tongue.
Getting caught up in arguments about whether or not a tongue tie impacts speech is not helpful. After reading this article, you can see that proper tongue mobility is so much more than just speech! We have to look at the whole child and the whole picture to make the best decisions.
If your current providers don’t support your concerns regarding your child’s tongue tie, search around for other professionals. There are many tongue tie professionals out there who really understand the long-term effects of tongue tie.
What to Do After a Tongue Tie Release
I know all of this information can be overwhelming! Or maybe it will give you a sense of relief to make sense of the challenges your child has. Either way, there is something you can do! An important and often overlooked next step is oral motor therapy.
For children under the age of 4, look for an occupational (OT) or speech and language pathologist (SLP) who has experience with tongue ties and oral motor treatment. For children with the cognitive level of a 4 year old, look for a myofunctional therapist.
These professionals can help work on tongue range of motion, strength, oral sensory processing, feeding, and overall establishing better motor patterns and habits. One easy way to work on these skills at home is using teething toys. Check out our article on how teething toys can help with oral sensory and oral motor development.
If you have concerns about your child’s airway, I recommended finding an ENT (ear, nose, and throat doctor). And if your child has a high palate or dental issues, look for an airway centric dentist.
How to Find a Provider
It is sometimes difficult to find a provider with the right experience. If you are having a hard time, there are some great resources online.
One place to search can be Facebook groups. You can search for a local tongue tie group and ask other parents for recommendations. You should always take parent recommendations with a grain of salt, since they only have their one experience to go on. Asking an experienced professional who has referred many patients to a provider may be more helpful.
Airway Circle has a great directory on their website. They also have a Facebook group where you can ask professionals in the group for recommendations if you cannot find a provider through their website.
Giselle Tadros is a well known physical therapist in the tongue tie world who runs the Instagram page @milkmatterspt. Her story highlight “finding help” offers a variety of other options for finding providers.
Guilleminault, C., Huseni, S., & Lo, L. (2016). A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ open research, 2(3), 00043-2016. https://doi.org/10.1183/23120541.00043-2016
Won, D. C., Guilleminault, C., Koltai, P. J., Quo, S. D., Stein, M. T., & Loe, I. M. (2017). It Is Just Attention-Deficit Hyperactivity Disorder…or Is It?. Journal of developmental and behavioral pediatrics : JDBP, 38(2), 169–172. https://doi.org/10.1097/DBP.0000000000000386