Are you wondering whether your child’s tongue tie needs to be released? Many parents researching tongue ties (ankyloglossia) feel overwhelmed by conflicting information. Some say every tongue tie should be released, while others claim it’s unnecessary. The truth lies somewhere in between. The decision should be based on function, not just appearance. Here’s a guide to help parents determine if a tongue tie release is the right choice for their child.
Signs Your Child May Need a Tongue Tie Release
According to the Academy of Orofacial Myofunctional Therapy (AOMT) and leading experts like Dr. Soroush Zaghi and Dr. Richard Baxter, tongue tie release is beneficial when restrictions cause functional impairments, such as:
1. Infant Feeding Issues
- Poor latch, clicking sounds, or maternal pain while nursing (Geddes et al., 2008; AOMT)
- Difficulty sustaining suction, excessive gas, or frequent reflux
- Prolonged feeding times or poor weight gain due to ineffective milk transfer
2. Speech and Oral Motor Development Delays
- Difficulty producing sounds that require tongue elevation (/l/, /r/, /t/, /d/, /n/) (Messner & Lalakea, 2002)
- Limited tongue mobility affecting speech clarity
- Speech frustration or avoidance
3. Chewing and Swallowing Difficulties
- Preference for soft foods, difficulty chewing solids
- Excessive food residue in the cheeks
- Frequent choking or gagging during meals
4. Mouth Breathing, Sleep, and Airway Concerns
- Mouth breathing instead of nasal breathing, which can affect facial growth (Guilleminault et al., 2016)
- Snoring, restless sleep, or sleep-disordered breathing due to restricted tongue posture
5. Orthodontic and Myofunctional Therapy Considerations
- Open bite, high/narrow palate, or crowded teeth due to low tongue posture
- Habitual tongue thrusting or incorrect swallowing patterns
- Persistent thumb sucking or pacifier dependence
When to Delay or Avoid a Tongue Tie Release
1. No Functional Symptoms
If your child has a tongue tie but is eating, speaking, and breathing normally, a release may not be necessary (Ferrés-Amat et al., 2016).
2. Skipping Pre- and Post-Release Therapy
- Pre-release myofunctional therapy is essential to prepare the tongue and surrounding muscles for proper movement after the release. Strengthening tongue posture, coordination, and oral function beforehand reduces complications and improves outcomes.
- Post-release myofunctional therapy is equally critical. Without exercises to promote correct tongue function and mobility, the frenulum may reattach, causing scar tissue, restriction, and a return of symptoms (Yoon et al., 2017). Post-release therapy includes tongue elevation exercises, oral strengthening drills, and neuromuscular retraining to ensure long-term success.
- Craniosacral Fascial Therapy (CFT) is a highly effective complement to myofunctional therapy. By gently releasing fascial tension throughout the body, CFT helps optimize tongue mobility, reduce oral restriction, and improve overall function. In some cases, a combination of myofunctional therapy and CFT may prevent the need for a tongue tie release altogether, as therapy alone can restore tongue function without surgical intervention.
3. Extreme Oral Aversion or Sensory Sensitivities
- Children with severe oral defensiveness may need feeding therapy before undergoing a release (Overland & Merkel-Walsh, 2020).
4. Mild Restriction or Misdiagnosis
- Some children have coordination difficulties rather than an actual tongue restriction. A comprehensive functional assessment is necessary before proceeding (Mills et al., 2019).
5. The “No Man’s Land” Age Issue
- Some children between 9 months and 4 years old fall into a difficult age range where they may struggle with post-release exercises but also have emerging speech and feeding challenges. In these cases, therapy first may be the best course of action before release.
6. Considering Alternative Release Options
- A laser frenectomy is a precise and often preferred option for tongue tie release. However, some ENT specialists may offer a tongue clip (scissor frenotomy), which can be effective for younger infants. The best option depends on the child’s individual needs and provider expertise.
Schedule an Evaluation with PedsTeam
If you’re concerned that your child’s tongue tie is affecting feeding, speech, or oral development, our expert team at PedsTeam is here to help! Our pediatric feeding and myofunctional therapists specialize in comprehensive assessments to determine whether a tongue tie release is truly necessary and how therapy can support your child’s development.
We take a functional approach—not every tongue tie requires release, and in some cases, Myofunctional Therapy combined with Craniosacral Fascial Therapy (CFT) can improve tongue function without surgery. If a release is needed, we’ll guide you through every step, ensuring the best possible outcome with pre- and post-release therapy.
Contact Us to schedule an evaluation.
References:
- Geddes, D. T., et al. (2008). Tongue movement and intra-oral vacuum in breastfeeding infants. Early Human Development.
- Messner, A. H., & Lalakea, M. L. (2002). The effect of ankyloglossia on speech in children. Otolaryngology–Head and Neck Surgery.
- Guilleminault, C., et al. (2016). The impact of sleep-disordered breathing on orofacial growth. Sleep Medicine.
- Ferrés-Amat, E., et al. (2016). Diagnosis and treatment of ankyloglossia: A comprehensive review. International Journal of Pediatric Otorhinolaryngology.
- Yoon, A. J., et al. (2017). The impact of tongue-tie release on oral function and development. Journal of Clinical Pediatric Dentistry.
- Overland, M., & Merkel-Walsh, R. (2020). Functional assessment and treatment of pediatric feeding disorders. Pediatric Feeding Institute.
- Mills, N., et al. (2019). Myofunctional therapy and its role in tongue-tie management. Journal of Orofacial Myology.
