Evaluation of speech intelligibility in children with tongue‐tie

Infants who experience breastfeeding difficulties may be referred for evaluation and frenotomy of a tongue-tie as the potential cause for breastfeeding difficulties. This procedure has become common practice and is supported by the American Academy of Pediatrics Section on Breastfeeding that recommends treating symptomatic tongue-tie early during infancy (1). Long-term effects of frenotomy in children with tongue-tie have not been previously reported, including subsequent speech intelligibility, yet it is widely believed that untreated tongue-tie causes speech articulation difficulties (2,3). Children tend to acquire control over most consonants by preschool age. According to Mann and Foy (4), at least 85% of the children in the Iowa Nebraska Articulation Norms Projects were able to produce the following sounds in initial and final position: ⁄ p, b, k, g, t, d, w, m, n, h, j ⁄ by the age of 4 years. These children were less proficient in producing ⁄ r, f, l, v, th (the), th (think), s, z, sh, j, ch, dz ⁄ . Hebrew-speaking children also acquire control over most of the consonants ⁄ b, m, p, n, j, f, x, k, l, t, g, r, d ⁄ by the age of 4 years, while the phonemes ⁄ s, z, sh, ts, h, v ⁄ are developed by the age of 5 years and above (5). We conducted this preliminary study to determine whether articulation and speech intelligibility affected children who underwent frenotomy in early infancy compared with children with no tongue-tie. The study protocol was approved by the Tel Aviv Medical Center Institutional Review Board for human experimentation, and informed consent was obtained from the parents. We recruited children who underwent frenotomy of tongue-tie during infancy, performed between the age of 2 days and 4 weeks (6) who were now 4–8 years of age. At the time when these frenotomies were performed, the distinction between types (i.e., classic and posterior) and classification of grades have not yet been described. We studied age-matched children with untreated tongue-tie whose parents reported a history of breastfeeding difficulties (nipple pain during nursing, difficulties in latching or both) and children with no tongue-tie as controls. A standardized articulation test (7,8) was administered to all study participants by two speech pathologists who were unaware of the group assignment. The test consists of 32 pictures of common Hebrew words of 1–3 syllables. The articulation of each word was audio-recorded for later scoring. Sentence production for picture presentation and fluent story telling according to a set of four pictures was also audio-recorded for later evaluation. Word production accuracy by percent errors and word-, sentence-, and fluentspeech intelligibility were assessed by two independent speech pathologists, whose final decision was by unanimous agreement. Speech intelligibility was scored on a scale of 1–4 (1 = intelligible speech) by assessing production of single words, sentences and fluent-speech comprehensibility. The children’s oral anatomy and tongue movements were evaluated by performing 10 different tongue movements from a standard oral motor evaluation test (i.e. protrusion, elevation, left and right movement, licking of the lower and upper lips, clicking, touching the hard palate, elevation of mid-tongue towards the hard palate) (9). Their performance of the tasks was scored as 0 for normal movement and 1 for distorted movement or inability to perform the task. Mandibular retrusion, maxillary protrusion and the distance between the anterior teeth in the vertical aspect were recorded. T-tests or the Kruskal–Wallis test were used to compare the incidence of errors in Acta Pædiatrica ISSN 0803–5253