This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
R Therapy with Ankyloglossia
By Pam Marshalla
Q: Is the best approach for ankyloglossia to do a back r?
If the tongue-tip is tied down, the client will be unable to stretch the tip up and back far enough for a Tip R (retroflex R). You will have no choice but to teach a Back R. But, as you know, the Back R can be much harder for many kids. That’s an excellent reason to have the frenum surgically altered.
I always refer a client with a restricting lingua frenum for surgery, no matter their speech problem. This is because the restricting tongue-tip movement does not affect only speech. It also affects oral rest, stage one swallow, stage two swallow, dentition, occlusion, and the client’s overall facial appearance.
The stage one swallow problem is perhaps the most important reason because without the ability to clear the mouth of all food particles in preparation for the swallow, the child can be at risk of aspiration.
Would you recommend clipping the lingua frenum of an infant in any case? My newborn grandson has a short frenum, but is able to suck well from breast and bottle. His pediatrician has said to wait, not sure why. I can see that the tongue tip is not pointed, but pulled in some.
I would. Most kids get them clipped right at birth. Please go to http://www.pammarshalla.com/blog/search/frenum to see more info on this.
Restricted frenums should be revised at any age, as soon as detected. A newborn may be “nursing well” but may have: colic, long or frequent feeding, or milk remaining on the tongue giving it the appearance of thrush. The mother may have sore nipples or mastitis. Dr. Kotlow, a pediatric dentist from Albany, NY has an excellent presentation on his website: http://www.kiddsteeth.com. Another good site is Carmen Fernando’s, who is an SLP from Australia: http://www.tonguetie.net. This condition is undetected or ignored by physicians far too often!