I received a message from a concerned mother four days after her son’s 4th birthday. She told me that her son’s pediatrician had referred him for a speech evaluation. We scheduled an evaluation and I planned for it like I typically plan for a preschool evaluation- PLS-5, TELD-3. GFTA, observe interaction and play skills, etc. At the beginning of the evaluation, I gathered some information from his mother regarding his developmental history. During this conversation, she reported that she had been discussing her concerns with his pediatrician since her son was 2. Her primary concern had been that she cannot understand her son when he speaks. She voiced her concern that extended family members made fun of him for the way he pronounces words. The popular PCP told her that he would not refer him for speech evaluation until he was 4 alluding to the reason behind his unintelligible speech being a result of the family (including child) being bilingual. Mom trusted the well-respected PCP and patiently waited on her son’s 4th birthday to arrive.
Meanwhile, during the same time period, the mother took her son to the biggest and most popular pediatric dentist office in town. He received cleanings and check-ups right on schedule.
Back to present day… During the first part of the evaluation, the child did not produce many vocalizations. I administered the language assessments. I administered the articulation single-word assessment which did not qualify the child for articulation therapy. I took data on his speech intelligibility at the sentence and conversation level. I grabbed some gloves and a flashlight and began to examine his oral mechanism. Guess what I found? I will let the pictures (published with mother’s permission) tell the story…
Ta da. The elusive tongue tie. My first internal reaction was “Yes!! We can fix this!” but my mind soon turned to disbelief. Disbelief that the lactation consultants didn’t look at his tongue when his mother had difficulty breastfeeding him. Disbelief that his PCP has never looked under his tongue. Disbelief that pediatric dentists haven’t caught this. The more I fret about it, the more sense it made to me how/why it had never been discovered. Case in point: At the doctor’s office, what do doctors tell their patients to do when they want to look in their mouths (most frequently at their throats)? “Open up and say ah!” Would the doctor be able to get a good view of the lingual frenum with patient saying “aaaahhhhh”? Nope, absolutely not (although one would think he would notice if the tongue was minimally protrusive). Case in point: At the dentist’s office, what position are you in when the dentist takes a look in your mouth? You are reclining back with gravity working to pull your tongue to the back of your mouth. I have spent numerous hours in a dental chair and not once have I been asked to elevate or lateralize my tongue. I shared my thoughts concerning the lack of identification of tongue ties with my own PCP. She wholeheartedly agreed with my theory about how tongue ties can be missed by a good number of medical professionals. I think that after our discussion she will start taking a closer look for possible tongue ties.
I feel obligated to provide tongue tie information to anyone who will listen to me: doctors, dentists, mothers, fathers, my own two children. I remain astounded by how this Class 1, glaringly obvious anterior tongue tie was missed by so many medical professionals.
Would you like to see this speech superstar’s tongue after tongue tie revision surgery? If so, check back in a few days and I will share some post op pictures, his mother’s perspective on the procedure, and speech improvements one week post-frenectomy.
Peace, love and speech therapy.