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FAQ Part 4
FREQUENTLY ASKED QUESTIONS
about Speech-Language Pathology
Caroline Bowen

Tongue-tie
Dear Dr Bowen, We have a seven (7) year old son with tongue tie. He was speech delayed but was able to leave speech therapy at age 5 and now has no articulation problems and does very well in school. His pediatrician told us he doesn't need surgery but the dentist says he does. He has some drooling and is a picky eater. My questions for you are: 1. Do you know of any experts in the United States, particularly in Texas if possible, in the tongue-tie area (i.e. surgeons and speech pathologists)? 2. What are the chances that having this surgery could actually cause our son to have some speech problems, given that he does not seem to have any at present? Thank you so much for your help and God Bless!

RESPONSE: Seek an SLP assessment
ASHA Search Engine Search for a Certified SLP in your area

More on tongue-tie
Dr. Bowen, Recently, my cousin, a speech pathologist, noticed my daughter's tongue-tie condition. Marissa, my daughter, will be three years old this month. She is a bright, happy girl and she is very chatty. We find her language clear but certain sounds (like D and L) are not pronounced. We found your website very helpful. We have also found that this condition and the treatment are subject to much debate. We have read Carmen Fernando's book and assessed that Marissa has very limited lateral and upward tongue movement. Our pediatricians in the US and the UK think any surgery is ridiculous. I would, nevertheless, like to discuss Marissa's language skills with a speech pathologist, We are moving to London this week--and were hoping you can recommend a speech center or pathologist. Thanks in advance for your help.

Hello I was recently told that my 5 month old son's skin under the tongue is too tight (short) I was advised to do nothing at this point because the pediatrician said most baby's will stretch out on its own and it is usually not a problem. I am not one who is comfortable to just wait and see so I was looking for some information since I know nothing about this. Should I wait? Are there exercises I can do with my baby to help stretch this piece
of tissue? Other than this he is a very healthy baby. Please send some information.

RESPONSE: Seek an SLP assessment
There is information about tongue-tie here.

Tongue "out" while talking
My two and a half year old son is speaking remarkably well for his age but he has a noticeable tongue thrust lisp. I asked my pediatrician whether it would correct itself or if I should correct my son's pronunciation. He said to let it be and that most likely my son will learn to avoid using words with the "s" sound (develop a vocabulary not using the tongue thrust "s" sound). I'd like him to continue saying "please" and "yes" into adulthood the correct way. Do I need to do anything at this point?

RESPONSE: Two year olds protrude their tongues
Lisping is normal until around 4 1/2 years of age. There is information about typical speech development here. Lisping and tongue thrusting are not the same thing. A tongue thrust is the tongue movement pattern that an infant uses when swallowing (SEE BELOW). Sometimes it persists past infancy / toddlerhood and may require remediation. Some children with tongue thrusts ALSO lisp (because lisping is normal in under 4 1/2 year olds - NOT because they are tongue thrusting). The phenomenon the paediatrician mentioned is called lexical avoidance (or lexical selection) and it is unlikely to occur in your son unless you draw undue attention to his 's' an 'z' sounds. Do not coach your little boy to produce correct esses and zees at this stage. It is unnecessary to do anything more than modelling the correct sound in your own speech. There is more information about normal speech and language acquisition here.

Protruding tongue
Dear Dr Bowen, My wife and I are concerned about something we have recently noticed in our 2 1/2 year daughter. She is very bright and has a large vocabulary. However, we have noticed that when she says certain words such as "teddy", "ready", "better", her tongue comes out of her mouth. We thought this funny at first, and her pronunciation is very clear with these words, but my wife and I are a little concerned. This has just started and we're wondering if it's just a phase or if its the beginning of a problem. We would appreciate some information because we're not sure where to turn. Sincerely, ---

I enjoyed your site. It's interesting to see how my 4yr old son measures on what is considered 'normal'. He has always spoken well since about 20 months of age and many people thought he was older than he looked because of vocabulary and ability to pronounce words. Would you give me information about lisping? Perhaps another word is used its place because I cannot find much on it. My 2-yr old daughter has a slight lisp on those consonants. Again, enjoyed your site!

RESPONSE: Two year olds protrude their tongues
Producing /t/ and /d/ with the tongue protruding beyond the teeth is PERFECTLY NORMAL at 2;6. To be quite sure, consult an SLP.

RESPONSE: Tongue thrust
All babies use a suckling (back-and-forth) action with the tongue when they are introduced to baby food for the first time. They may push the food back out of the mouth, especially if there is too much on the spoon for them to manage. This aspect of normal development is different from "tongue thrusting", and generally continues until about 6 to 9 months of age, when the baby accomplishes an up-down sucking movement, which they are able to combine with the original in-out movement.

One year olds are typically using the up-down action habitually (all the time). Some children persist in swallowing with the tongue touching or between the front teeth until they are much older. This action is what myofunctional therapists and dentists call a "tongue thrust swallow".

The more common use of the term "tongue-thrust" is in medicine where it is applied to the strong, reflexive, outward-pushing movement of the tongue seen in children with neurological dysfunction (as cerebral palsy or traumatic brain injury). Typically developing babies may use a comparable forceful movement when they are learning to manage spoon feeding if large amounts of food (that they can't handle) are plopped into their mouths.

It takes practice for babies to learn to take the food from a spoon and "work" it back with the tongue using a smoothly co-ordinated forwards-backwards movement, in preparation to swallow. If food is deposited in their mouths unexpectedly, or in quantities that are too large, the baby automatically pushes it out (using a survival reflex).

Unintelligible speech at 33 months
Dear Caroline, I have a 33 month old son. He is a second child and his sister is 4 years older than he is. He is starting to talk more and more, but some of what he says is unintelligible. His sister seems to understand him and relays the message. Is his delay in speaking more clearly related to the older sibling and her willingness to speak for him? Also, my son just recently started repeating words back to me when he hears a new word, but a friend of mine has a son who is 5 months younger than my son and he has been doing that for months, how concerned should I be that there is a real underlying problem?

RESPONSE: Follow your instincts...
Follow your instincts. If you are concerned, seek an assessment by a certified speech-language pathologist. There is a wide range of "normal" at 33 months. And it is also normal for some of what he says to be unintelligible. A professional assessment will either put your mind at ease, or, if there is a problem, lead to having some strategies to use at home to encourage his language development.

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Page updated 04 Feb 2010

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