Q: I am working with a three-year-old with a very restricted lingual frenum, a shortened velum, and significant tongue protrusion. The parents want to try therapy before consulting medical advice about a frenectomy. We have made nice progress thus far. The child chews hard and soft solids with a mushing pattern. No coughing, choking, gagging has ever been observed or reported. She is now able to lateralize her tongue left and right independently of the mandible, and within the past month she has been increasingly able to use tongue to manipulate bolus to the other side. We have done some tongue-jaw isolation tasks, but have had limited success given the tightness of her frenum. We also use baby chew toys to try to achieve rotary movements. Any other suggestions would be greatly appreciated.

I always recommend clipping if therapy is not solving the tongue mobility issue. It sounds like you are doing everything you should, except perhaps to use resistance against tip elevation. Use a little downward pressure on the tongue-tip to see if it can help her learn to push the tip up higher.