Tongue Tie and Speech: Does It Affect Speech Development?

What Is Tongue Tie?

Tongue tie (ankyloglossia) is a congenital condition in which the lingual frenulum — the small band of tissue beneath the tongue — is shorter, thicker, or more tightly attached than usual, restricting the tongue's range of movement. It affects an estimated 4–11% of newborns, though estimates vary depending on the definition used.

Tongue tie is most frequently discussed in the context of breastfeeding difficulties: babies with significant tongue tie may have a shallow latch, cause pain to the breastfeeding parent, and struggle to transfer milk efficiently. This is the context in which tongue tie division (frenotomy or frenuloplasty) is most clearly evidence-supported.

But the question that concerns many parents of older babies and toddlers — whose tongue tie was either missed in the newborn period or not divided — is whether tongue tie affects speech development, and whether late division is beneficial for speech.

Types of Tongue Tie

Anterior tongue tie is visible to the naked eye: the frenulum attaches clearly to the underside of the tongue tip, and the tongue may appear heart-shaped or notched at the front when the baby cries or extends it.

Posterior tongue tie is a more controversial category. The frenulum appears normal at the front of the tongue but is thought to be tighter or more restrictive beneath the tongue mucosa, limiting tongue elevation and posterior movement. Posterior tongue tie is much harder to assess reliably, diagnosis requires skilled examination, and there is significant variation in how practitioners assess and classify it.

The lack of a universally agreed diagnostic standard for posterior tongue tie is relevant to the evidence base — many studies use different definitions, making comparison difficult.

How Tongue Movement Affects Speech

The tongue is essential to speech articulation. Many speech sounds in English require specific tongue movements:

• Tip sounds (lingual-alveolar): t, d, n, l — require the tongue tip to touch the alveolar ridge (behind the upper front teeth)
• Lateral sounds: l — requires the sides of the tongue to rise
• Sibilants: s, z, sh — require precise tongue shaping and airflow direction
• Retroflex sounds (less common in standard British English but present in many accents and languages): require the tongue tip to curl upward

If the tongue has significantly restricted elevation or extension due to a tight frenulum, it stands to reason that some sounds dependent on tongue-tip elevation might be affected. The theoretical mechanism is plausible.

What the Research Actually Shows

The evidence base for tongue tie and speech is considerably less clear than for tongue tie and breastfeeding.

Studies examining the association between tongue tie and speech disorders have found inconsistent results. Some studies report a higher prevalence of speech difficulties in children with tongue tie; others find no significant association. A systematic review published in the International Journal of Paediatric Dentistry in 2017 concluded that while some articulation difficulties may be associated with tongue tie, the evidence was of low quality and no definitive conclusions could be drawn.

The challenge of causation. Most children with tongue tie — including many with significant restriction — develop completely normal speech. The tongue has considerable capacity to compensate, and many speech sounds can be articulated adequately even with reduced range of motion. This compensatory capacity means that tongue tie does not reliably predict speech difficulties.

The evidence for division improving speech is even more limited. A 2023 Cochrane review on tongue tie and speech outcomes found insufficient high-quality evidence to determine whether frenotomy improves speech in children beyond infancy. This is partly because speech difficulties in childhood have many causes, and isolating the contribution of tongue tie restriction is methodologically very difficult.

What speech and language therapists say. Most SLTs take the position that tongue tie is one of many factors that may contribute to articulation difficulties, but it is rarely the sole cause and may not be the most important one. For children with identified speech articulation errors, the standard first step is a course of speech and language therapy rather than referral for tongue tie division.

Posterior Tongue Tie: A More Contested Area

The diagnosis of posterior tongue tie is significantly more contested. There are practitioners — particularly within private lactation and dental communities — who diagnose posterior tongue tie in a high proportion of babies referred to them, and who attribute a wide range of difficulties (breastfeeding problems, reflux, colic, sleep difficulties, and speech delays) to it. There are others — predominantly within mainstream paediatric medicine and speech and language therapy — who are more cautious about both the diagnosis and the proposed interventions.

The risks of frenotomy are low (the procedure is quick, involves very little blood, and complications are rare), but they are not zero. Significant reattachment, scarring, and the need for repeat division do occur. The debate about posterior tongue tie in particular is an area where parental information-gathering should include NHS-provided sources as well as private practitioners, who may have a financial stake in the diagnosis and treatment.

What to Do If You Are Concerned About Your Child's Speech

If your child is approaching 18 months and not yet saying single words, or approaching two years and not combining words, speak to your health visitor or GP about a referral to a speech and language therapist.

If your child is older and has specific articulation difficulties — difficulty with particular sounds — a speech and language therapist should be the first professional involved. The SLT can assess whether any restriction in tongue movement is contributing to the difficulty, whether therapy is appropriate, and whether referral for assessment of tongue tie is warranted.

Self-referral to speech and language therapy is possible in many areas of England via the NHS, though waiting times vary. The Royal College of Speech and Language Therapists (RCSLT) website lists services by area.

IBCLC and tongue tie specialists are the appropriate first referral for tongue tie concerns in the breastfeeding period. For speech concerns in older children, a speech and language therapist is the correct starting point — not a private tongue tie practitioner.

Summary

Tongue tie can affect speech in some children, particularly where there is significant restriction of tongue elevation required for specific sounds. However, the evidence that late division of tongue tie improves speech outcomes is limited and inconsistent. Most children with tongue tie develop normal speech, and for those who do develop articulation difficulties, speech and language therapy is the appropriate first intervention. Decisions about late division should be made in consultation with a speech and language therapist and, ideally, with NHS guidance rather than solely on the basis of private assessment.