Developmental Delay

Hi Sandra, I have a student, 5 year old, male. When I gave him an oral motor assessment he was unable to stick out his tongue and the sides of his tongue would “wing” outward. Recently, he was able to stick out his tongue without the wings when we returned back to school. He lifts his tongue, but the jaw goes with the movement and he uses his teeth to keep it on the top of the mouth. When I did give him an oral motor assessment, he refuse to do some of the tasks. Therefore, I do not know. He would shake his head “no”. In understanding this parent, she will take the peditrician’s word before my word and she will take the speech pathologist at the rehab center before my word. His most recent report from the rehab was the oral motor structures were adequate for speech. The drooling has stopped; however, he was put on medication this summer. The parent was taking him off of it and the drooling came back. He also was eating his shirt, etc. His teacher reported when he sneezed one day drool just flew out of his mouth and splatted onto the floor. I don’t know if the medication “dried him out”. He is dead weight so I assume the weakness is all over. When I measured his lip strength it was a 1. When I do the button excercises little effort is put into it. Therefore, I don’t know if his lips are weak or lack of motivation. HIs speech sounds almost dysarthric like. I am wondering if it is a posterior tongue tie. He may not be tongue tie, but it is a mystery with him. K

Hi K This is a bit complicated. How severe is his developmental delay? How old is he and how well does he follow directions? I can’t tell enough from the one photo about the function or appearance of the frenum. Do you have the Quick Tongue-Tie Assessment? Use the quick assessment we had in class if he understands what to do. Look at the lingual and mouth floor attachments.Get in his mouth and feel the frenum for size and composition. Drool is common with tongue tied children. You may recall that it is discussed in the TAP assessment by Carmen Fernando. If the SLP thinks he might be tongue tied, then you must make the determination since I doubt that pediatricians have the information you received at the course.   Also does the unilateral weakness extend into the mouth? Lips? Let me know your thoughts about this developmental delay.  Sandra