Q: I have worked with a 4-year-old for two years who had a frenectomy about 3 months ago. His speech is quite intelligible now, but he still has heart-shaped tongue, he cannot dissociate his tongue movements from his jaw movements, and he cannot sweep his tongue around lips to clean himself. He stabilizes his tongue with his teeth and can barely extend it beyond lower lip even after surgery. Since speech is good would you still see him for therapy?

Sometimes I am absolutely amazed that kids can speak as well as they do given their poor oral structure and function. I am sure this is one reason that so many people get up in arms about “oral-motor techniques.”

You said his speech was good, and he was intelligible, but you did not say that his speech was all fixed up. I am assuming that this client does not have all his consonants in, and still is having problems with some vowels and/or diphthongs. He sounds like he may still need therapy.

However, perhaps his errors are not of concern to you now. For example, perhaps his R is a mess, or he cannot do all consonant clusters, but because of his age you are not concerned about these things yet. This is a kid who is at risk for not being able to gain these more difficult skills when the time comes. I would at least keep an eye on him to see how he does as expectations raise, and as his speech has to get gets more complicated over time.

I have seen some kids who resolve their artic problems in therapy during the preschool years, but who show up as fluency cases later on. He is worth monitoring at least for that.

Also, I imagine that his feeding skills are poor. He probably is a messy and picky eater who does not handle food well in terms of his ability to completely evacuate the mouth and to swallow efficiently. I would be working on feeding skills and oral-tactile awareness and discrimination in my practice with him.