When ENT advises Mom not to do anything related to tongue-tie

I hope all is well!!

I was hoping you could answer a couple of questions for me.  I had a 3 year old client with a tongue tie with anterior attachment. I sent him to an ENT and they confirmed the tie but advised Mom not to do anything at his young age.  He also has muscle weakness and dis-coordination. This child is 90% unintelligible and also occasionally pockets food in his cheeks. He drools and very often has his tongue thrusted forward.  He is also a chronic thumb sucker with a large open bite.    I was asking Mom to get a second opinion regarding a frenectomy .  She said that the ENT and pediatrician do not feel the TT release is necessary because his tongue can extend forward a good amount.  I have never seen him be able to elevate his tongue though.  If he is able to extend his tongue forward should he also be able to elevate his tongue?

Mom ended up calling me yesterday and said they are going to try working with another SLP.  Was I wrong in thinking he needed a frenectomy? I know it is hard for you to say without seeing him but I would love to know your thoughts.  I guess my ultimate confusion is, if a person can extend their tongue forward to their chin, does that mean they don’t have a severe enough TT to warrant it getting released? I really did feel it was impacting his speech and feeding but I’m worried I was wrong.

Thank you!
With warmth and gratitude,

Hi,

I will respond in bold within your email, pasted below:

I had a 3 year old client with a tongue tie with anterior attachment. Since you say anterior attachment, might I assume that it is right up to and even over the “tip”?? Indented?  I wish you had taken a photo to share….it makes it very much easier much of the time, so try to remember to make that part of your first session.

I sent him to an ENT and they confirmed the tie but advised Mom not to do anything at his young age.

Sorry to hear that!  We would not want to wait until there is a more severe problem or that the child becomes a teen and then an adult who is ankylosed.  Most likely, mom did not spend time researching an ENT with expertise in that area. 

He also has muscle weakness and discoordination.

Those are general terms.  Are they yours or someone else’s?  If yours, then you have to be more specific….remember we talked about avoiding general terms like “muscle weakness” unless you have something concrete to back it up. 

This child is 90% unintelligible and also occasionally pockets food in his cheeks. He drools and very often has his tongue thrusted forward.  He is also a chronic thumb sucker with a large open bite.    I was asking Mom to get a second opinion regarding a frenectomy .  She said that the ENT and pediatrician do not feel the TT release is necessary because his tongue can extend forward a good amount.

But is the actual tip extending forward, or it is anchored down and the portion behind the tip is what is being extended out?  

I have never seen him be able to elevate his tongue though.   If he is able to extend his tongue forward should he also be able to elevate his tongue?

Recall from class that three year olds cannot elevate the tongue upon request.  You have to explore within the oral cavity, feel and view the frenum, etc. to know exactly what is going on.

Mom ended up calling me yesterday and said they are going to try working with another SLP.  Was I wrong in thinking he needed a frenectomy? I know it is hard for you to say without seeing him but I would love to know your thoughts.  I guess my ultimate confusion is, if a person can extend their tongue forward to their chin, does that mean they don’t have a severe enough TT to warrant it getting released? I really did feel it was impacting his speech and feeding but I’m worried I was wrong.

It sounds like you were right on target!  Without seeing a photo or getting a more explicit description of the floor-of-mouth and lingual attachments, I am not positive, but based on what you said….it sounds like you did the right thing to recommend release.  Don’t be too hard on yourself and don’t let this deter you from using your knowledge because all of us come up against parents and medical professionals who don’t know what we know and don’t understand the value of our training.

I hope this helps you feel better about what you decided to recommend and also that it encourages you to follow some of the suggestions I made to help out with future situations.  Keep in touch and I really enjoyed having you in class.

Sandra