05/02/2024
Here’s a tongue-tie in a 6-year-old I saw today.
The presenting concern was frustration and lack of progress with speech therapy. Two to three years later, with many changes in therapists, going in many different directions, the last therapist said everything was fine for her age.
Still grappling with persistent speech concerns, mum has also sought ENT evaluation.
The ENT diagnosed a tongue-tie but said to leave it. Mum was confused as despite a history of breastfeeding challenges including pain, latching difficulties, and symptoms of air-induced reflux, multiple lactation consultants, and all her speech therapists have not noted it prior.
She has had surgery to insert grommets to help address mild hearing loss, and removal of adenoids. A year later, she is still having ongoing ear infections, requiring constant rounds of antibiotics, and an x-ray has confirmed regrowth of the adenoids. The ENT has said to have them out again, but through a friend, mum has started to question whether it could be the mouth that could be contributing to the speech problems.
She had a very slow transition to solids. She would only like smooth purees and took a long time to eat as soon as texture was introduced. Mum describes her as the slowest eater she has ever seen in her life.
In the mouth, I see one of the strongest red flags of breathing problems – teeth grinding related tooth wear. She has a constricted palate and tongue-space.
It turns out she is a hot and sweaty sleeper, with a history of disturbed and fragmented sleep. She is not refreshed in the morning, and there are significant concerns with emotional regulation, and anxiety.
This is not an uncommon story. I feel a deep sense of despair for parents doing their absolute best to get answers and experiencing years of conflicting advice and dismissal of their concerns. Often parents are frustrated and overwhelmed to tears during consultation. And there needs to be a day where people are not driving for hours or flying in to get answers.
I’d like a future where every lactation consultant, speech therapist, ENT specialist, dentist and more is trained to understand that we need to pay attention to tongue elevation.
We need the tongue to lift well for
✅ Efficient drainage during breastfeeding
✅ Good swallowing and eustachian tube clearance
✅ Speech perception and articulation
✅ Palate development
✅ Good breathing and sleep
And when we allow compensations and overuse muscles of the face, jaw, and neck during oral functions, the ultimate problem is that we don't develop the proper tongue tone and posture for good breathing, sleep, and a child to thrive to their full potential during the day.
We need to question whether breastfeeding, chewing, swallowing, and speech problems could be related to how the muscles of the mouth are working. And if we recognise those same muscles are those that affect how airway grows and functions – we need to be in-tune for signs of airway problems in children.
As professionals, let’s start recognising the whole child – not just the immediate concerns but laying the foundation for a thriving future. Check out Inspiration by Integration 2024: A Practical Guide to Children's Airway Health - which will spark lots of new conversations on integrative care.
Parents, find empowerment in connecting the dots, and gain confidence in advocating for your child to build more professional curiosity and collaboration.
