Lingual band is the common name for the lingual ligament. It is a thin strip of tissue between the tongue and the floor of the mouth when the child opens the mouth and tilts the tongue, and it is a mucosal tie between the sublingual area and the alveolus formed in the midline. Normally in newborns, the lingual tether extends to the tip of the tongue or close to it. During the development of the tongue, the tether gradually recedes toward the tongue root, so infants are not born with their tongues freely extended, but start from short to just being able to suck, and then begin to pronounce words due to the need to drink milk, speech, etc. After a long series of related activities and exercises for several years, this makes the tip of the child’s tongue gradually move away from the tether and thus towards normal. A short tongue tie is a congenital developmental abnormality, mainly manifested by the short tongue tie at the bottom center of the tongue, so that the normal activities of the tongue are restricted, so the tongue can not be extended to the outside of the mouth, or upward can not touch the upper lip; when the tongue is stretched forward, because of the short tongue tie pulling the tongue, so that the back of the tongue has a small depression, the tip of the tongue is “V” or “W” shape. In severe cases, it affects sucking, speech clarity and language learning. The condition is commonly known as “big tongue”. I. Diagnosis and evaluation I don’t know when the concept of short tongue tie has been widely spread among the people, so many children just learn to speak, as long as there is unclear speech, parents will first associate it with the tongue tie problem. In fact, only a very small number of children with abnormal development will have a short tongue tie. If one end of the tongue tie is attached to the tip of the tongue and the other end is attached to the front side of the floor of the mouth, this restricts the movement of the tongue and prevents it from extending outward and licking upward to the palate, then the tongue tie can be judged as too short. Generally speaking, it is best to observe until after 2 years of age, when the tip of the tongue starts to gradually move away from the tether. If the short tether does affect the forward extension of the tongue and even prevents clear speech, a diagnosis can be made and further treatment sought. The short lingual tether often causes ulcers when the two lower incisors rub against each other during suckling in infancy. The short tongue ligament also restricts the movement of the tongue in the mouth, which affects the spitting and pronunciation of words, especially the curl, palatal and lingual sounds, such as /l/, /r/ and /ch/ in the Hanyu Pinyin alphabet. Due to the restricted tongue movement, it will also have a certain impact on chewing. Third, common misconceptions 1, infants with short tongue tether is not normal Some parents find that the infant tongue tether is relatively short, the tip of the tongue can not be upturned when opening the mouth, tongue activity is not flexible, it is considered abnormal. In fact, the infant’s tongue tie is in the developmental stage. In the neonatal period, the tongue tie is extended to the tip of the tongue or close to the tip of the tongue. During the development of the tongue, the tongue ligament gradually recedes toward the tongue root, and the tip of the tongue gradually moves away from the tongue ligament only after the age of 2 years in normal children. Therefore, in infancy, the lingual ligament becomes more tense and the lingual ligament can appear “too short”, which is a temporary physiological phenomenon and should not be considered abnormal. With the growth of age and the eruption of milk teeth, the attachment of tongue tie will gradually move down to the bottom of the mouth, gradually become thin and loose, the mobility of the tongue will also become more flexible, and the tongue tie will not be short. Some parents attribute their children’s inability to pronounce to the short tongue tether, and take their children to the hospital to have their tongue tether cut as long as they have the performance of unclear speech. The inability to pronounce and spit out words is certainly related to the short tongue tie, but it is not the only reason for the inability to pronounce. The short tongue tie usually only affects the child’s inaccurate pronunciation of certain words, but does not play a major role in the overall pronunciation. There are two main causes of mispronunciation: one is congenital physiological defects, such as congenital cleft lip and palate, missing or malformed teeth and short tongue tie; the other is due to acquired diseases, such as uncoordinated vocal movements due to neurological diseases, inability to hear and imitate correctly due to hearing impairment, and brain developmental disorders, which can cause mispronunciation. In addition, the vocabulary of children before 3 years old gradually increases, and they want to use language to express their own thinking, so they often have inaccurate pronunciation, especially some complex sounds. This is because they have just learned to speak, and the language center and vocal organs of the brain are not mature, or they are influenced by the language environment in the process of learning to speak. Some parents worry that the short tongue tie will affect their children’s pronunciation and speech, and insist that the doctor do the surgery early, thinking that early surgery does not require anesthesia, no stitches and less bleeding. However, if the surgery is done too early (at the age of 2-6 months), it will easily lead to scar formation of the surgical wound, and some children will have to have a second surgery. Moreover, most of the children do not cooperate well with the doctor during the surgery, and the slightest carelessness can easily cause misinjury and co-infection. In addition, the psychological impact of premature surgery can be even greater than the physical damage caused to the child. The recommended time for surgery is after the age of 4 and around the age of 5. This is because the tongue tie gradually shifts backwards as the child gets older. Even if the tongue tie is too short, it can be improved with training and most children do not experience dysfunction. A child’s articulation is related to factors such as auditory function, language environment, intellectual development, and degree of articulation. These factors become more refined at the age of 4 years, therefore, children before the age of 4 years or younger can be observed and followed up. If a child is found to have tongue tie problems early, it is recommended not to blindly “cut the tongue tie” too early. It is best to go through professional judgment or further observation, along with appropriate tongue motor training or speech therapy, as most children do not need to undergo this procedure.