What is lingual tethering? The lingual band is the common name for the lingual tether. It is a thin strip of tissue between the tongue and the floor of the mouth when the child opens his or her mouth and lifts the tongue. A normal tongue ligament allows the tongue to move freely, with the tip of the tongue naturally sticking out of the mouth or licking the upper gums. Under normal circumstances, many newborns have a tongue tie that extends to or near the tip of the tongue. During postnatal development, the tongue tether gradually retracts backwards, so babies and children are not born with their tongues freely extended, but start from short to just being able to suck, and then gradually move away from the tether as they are forced to drink milk, begin to pronounce words due to speech needs, etc., thus moving towards normal. What are the signs of a short tongue tether? What are the consequences? If the tongue tether is too short, the normal movement of the tongue is restricted, and the tongue cannot extend beyond the lower lip or touch the upper lip; when the tongue is stretched forward, the tip of the tongue is in a “W” shape due to the short tongue tether pulling the tongue. There are also mild and severe tongue ties that are too short. In mild cases, the tongue can be extended beyond the lower lip and the tip of the tongue is located between the lower lip and the chin, but the tip of the tongue has a “W” shape. The tongue tethering is not only a significant obstacle, but also a significant obstacle to eating and speaking, which requires active intervention. In particular, a newborn with a short tongue tie will not be able to wrap the nipple around the tongue and suck on it, which may interfere with feeding. The risks of a short tongue tie include the inability to wrap the nipple around the tongue and suck on it as a newborn, which may interfere with feeding. In infants, a short tongue tie can cause ulcers on the tip of the tongue as the two lower incisors rub against each other while sucking. After the age of 1, the short tongue ligament also restricts the movement of the tongue in the mouth, which affects the spitting and pronunciation of words, especially for the curl, palatal and lingual sounds, such as the difficulty in pronouncing /l/, /r/ and /ch/ in the Hanyu Pinyin alphabet, which is commonly known as “big tongue”. In addition, due to the restricted tongue movement, it also has a certain impact on chewing. To cut or not to cut the tongue tie? The small “W” does not necessarily need to be cut. The small “W” is only a slight tug on the tongue tie, there is no obvious tongue movement, it does not affect the child’s sucking, as the child grows, the tip of the tongue will gradually move away from the tie, it will not prevent clear speech, it is recommended to observe and follow up before 2 years old, after 2 years old if it affects spitting and pronunciation, then surgical intervention can be considered. Children with large “W” need surgery as soon as possible, otherwise it will not only affect feeding, but also speech and language. When to cut? How to cut? Children under one year of age can have their tongue ties cut without anesthesia or surface anesthesia, which results in less bleeding, easier surgery, and does not interfere with feeding. Therefore, it is necessary to evaluate the thickness of the tongue tie and the child’s cooperation. If the tongue tie is thin, then direct cutting can be attempted. If the tongue tie is thicker, it is estimated that there will be more bleeding during surgery or if the child struggles vigorously, then it is safer to operate after intravenous anesthesia. For children older than 2 years, lingual ligamentoplasty under intravenous anesthesia is recommended. There are also options for how to “cut” the lingual ligament. The most common method is to use small sterile ophthalmic scissors to cut directly and apply local pressure to stop the bleeding. This procedure is convenient, economical, and a good choice for children with thin tongue ties or those under 1 year of age, and avoids the risks of general anesthesia. However, this surgical approach has a certain percentage of postoperative tongue tie re-adhesion, and because the postoperative wound is exposed, active postoperative movement of the tongue body is required to prevent adhesions from occurring. Other surgical options include lingual ligament clipping under intravenous anesthesia with trabecular sutures and low-temperature plasma radiofrequency ablation lingual ligamentoplasty. These two procedures are safe and reliable and have a lower incidence of postoperative adhesions in children older than 2 years old, or in children with thick tongue ties that fit closely to the floor of the mouth. The Shanghai Children’s Hospital has achieved excellent results in treating older children and complex tongue tie constrictions with cryo-plasma radiofrequency ablation. Is tongue tie to blame for slurred speech? Most parents, when their children have slurred speech, the first thing they think of is the tongue tie, but they do not know that a short tongue tie only affects the pronunciation of individual words. If your child’s speech is slurred, or if he or she still cannot speak at the age of 2, it is important to go to the ENT department for an examination to rule out hearing problems so as not to delay your child. There are also some children who have had surgery but still do not speak clearly. This is because speech is a complex process that relies on the cooperation of many organs, including the ear, brain, mouth and nasal cavity. The child also needs speech training after surgery, and parents need to help correct the child’s pronunciation. In fact, lisp is very common in children’s speech development. However, usually at the age of 4-5, children can pronounce “zh, ch, sh, r” in a standard way. If your child’s Mandarin is not standard, parents should correct it in time. Buy a Hanyu Pinyin pronunciation chart and teach your child to pronounce the words with their tongue in the correct position. With a sense of awareness, the child will be able to pronounce standard sounds. All in all, only a regular physician can find out whether the tongue tie is too short or not. Parents are right to take their children to the doctor as soon as possible if they have doubts.