What is a tongue-tie?

A tongue-tie is a condition that is present at birth. It looks like a short, tight, and thick tissue that is called a lingual frenulum. This tissue is found at the bottom of the tongue, that can make it hard for the tongue to move freely.

Causes

Typically, the tissue separates before birth, allowing the tongue to move around freely. With a tongue-tie, the tissue remains attached to the bottom of the tongue and restricts the movement, causing complications with breastfeeding and speech articulation development. There is no known reason or cause for this, although some research has indicated that cases of tongue-tie have been linked with certain genetic factors.

Complications

• Breastfeeding
  – Latching
  – Feeding efficiency – how much milk they take per suck
  – Maternal pain and milk supply
  – Early weaning
• Bottle Feeding
  – Creating a seal and dribbling milk
  – Very slow bottle feeds
  – Difficulty controlling milk flow
• Solids
  – Slow transition to solid foods
  – Gagging on lumps of food
  – Chewing difficulties
  – Messy eating.
• Oropharyngeal dysphagia risk: The child has difficulties initiating a swallow, resulting in a higher risk of food or liquids going down the wrong way and into the lungs.
• Potential for food refusal
• Speech difficulties: Tongue-tie can interfere with the ability to make certain sounds — such as “t,” “d,” “z,” “s,” “th,” “r” and “l.”
• Poor oral hygiene: for an older child or adult, tongue-tie can make it difficult to sweep food from the teeth. This can contribute to tooth decay and inflammation of the gums. Tongue-tie can also lead to the formation of a gap or space between the two bottom front teeth.

Treatment:

Surgical treatments:
Frenotomy: The lingual frenulum is cut,
Frenectomy: The lingual frenulum is surgically removed
Frenuloplasty/z-plasty: Helps to release scar contracture and relieve soft tissue tension

The treatments would be performed by a surgeon.

Written by Nour Sleiman, Speech Pathologist at De Silva Kids Clinic.

Who is this treatment for?

 This treatment is designed for children 6 years and younger who stutter. The children who participate in this program can have all different levels of severity for their stutter, as this does not impact the effectiveness of the treatment. It may be suitable for some older children and your trained Speech Pathologist can advise this. 

What is the treatment? 

The Lidcombe Program is a behavioural treatment where the Speech Pathologist indirectly treats the child’s stutter by training the parents/caregiver on  how to deliver the program at home. As it is an  intensive treatment, the majority of the program is required to be completed by a parent/caregiver as they spend the most time with the child. 

The program teaches the parent/caregiver to ignore the child’s stutter and praise their smooth speech. 

There are 2 stages of the treatment program. These are: 

Stage 1: Weekly sessions with Speech Pathologist, parents/caregiver and child. Daily practice sessions at home with parent/caregiver. 

Stage 2: Maintenance of reduced/no stutter at home in any environment. Attend monthly – 3 monthly appointments with Speech Pathologist to check on progress at home. 

Stage 1:

 The parent/caregiver and child attend weekly sessions with their Speech Pathologist. These weekly sessions are for the Speech Pathologist to train the parent/caregiver on how to provide the treatment by demonstrating various features of the program, observing the parent/caregiver providing the treatment, Speech Pathologist to give feedback on what was observed, discussing what was conducted at home during the past week and negotiating a Severity Rating of the child’s stutter for the session.  

The parent/caregiver are to conduct daily practice  sessions at home with the child. These practice  sessions are recommended to last for 10-15  minutes and can be conducted twice a day if your  Speech Pathologist recommends it. The purpose of    the practice sessions are to elicit stutter free speech     so that the parent/caregiver can give praise for the child’s smooth speech. Therefore, praising the behaviour we want to see (smooth speech) and changing the behaviour. This verbal praise is called Verbal Contingencies (VC) – for example, “super smooth”.  

The Speech Pathologist will guide the parent/caregiver on how to structure the practice session to achieve stutter free speech. The aim of the program and practice sessions are to achieve unstructured and conversational speech that is stutter free. Towards the end of stage 1, we are expecting the child to be stutter free – very mild stutter. Once this has been achieved over 3 consecutive weeks, then the clinician will recommend the transition to stage 2. 

Stage 2:

Stage 2 is dedicated to the maintenance of the stutter free speech/very mild stutter and this stage can last up to a year. This will consist of reducing the number of sessions with the Speech Pathologist to monthly – up to 3 monthly and training the parent/caregiver on how to identify any sign of a relapse in the stutter and how to approach this within the Lidcombe program. Sometimes this can be to return to some practice sessions at home or simply just increasing the verbal contingencies (praise) within conversation. 

Once stage 2 is completed, Speech Pathologist will discharge your child from the Lidcombe Program. 

However, maintenance is often lifelong for most people who stutter. 

Evidence behind treatment:

Independent reviews report the evidence base for the Lidcombe Program to be the most comprehensive for early stuttering treatments. The evidence base includes children from the following countries: Australia, the United Kingdom, New Zealand, the United States, Canada, the Netherlands, Sweden, Malaysia, Kuwait, and Iran. An analysis of 134 children in a randomised controlled clinical evidence and randomised controlled trials for the Lidcombe Program showed that its odds ratio was 7.5 for attaining below 1.0 percent syllables stuttered at 6.3 months post-randomisation. This means that, at 6.3 months post-randomisation, children who received the Lidcombe Program had 7.5 times greater odds of having no stuttering or almost no stuttering than children who did not receive the Lidcombe Program. 

This research shows us as clinicians and you as parents, that this program has strong evidence supporting its effectiveness for treating a child 6 years and younger for their stutter. 

Written by Allie Godbold, Speech Pathologist at De Silva Kids Clinic.

Imagine that you are having a conversation with someone but you have not really processed or “heard” what they said? What would you do? Maybe you ask them to repeat themselves, which would help you to process the information. This can happen to all of us sometimes, BUT this is happening constantly for some children. Try to imagine paying attention and learning all day with this difficulty!!

Your child may have adequate hearing (where their ears are sending the sound to their brain) but poor auditory processing (their brain doesn’t match up the sounds properly). This is called Auditory Processing Disorder (APD or CAPD).

But, what is the difference between HEARING and AUDITORY PROCESSING? A common misconception is that APD is a hearing problem. Hearing is when the sounds collected by your ear is sent to the brain. Auditory processing is “what we do with what hear” – so when your brain notices and uses the sound.

Some of the signs of APD to look out for in a child are:

• Forgets what is said in a few minutes
• Easily distracted by background noise
• Does not listen carefully to instructions and often requires directions to be repeated
• Says “what”, “huh?” or “pardon” at least 5 times a day
• Learns better one-on-one

Some suggestions, in the areas of attention, seating, instructions and time, can help children with (C)APD be successful.

Attention

• Speak at eye level: speak at your child’s eye level, get close to your child, and face them to provide clear information
• Use cueing: cue your child to become aware of times when they are not paying attention. Use words, such as “listen”, “are you ready”, and “remember this one”

Seating

• Quiet study/work area: Provide your child with a quiet area for a better learning environment.
• Avoid noisy sources: Seat your child away from distracting noise sources. For example, TV, loud music, kitchen appliances when they are trying to listen to the speaker. Seating your child away from windows and doorways will also reduce distraction.

Use daily routines: Use daily schedules to help your child stay focused and organised. Sample Bedtime Routine:

8:00 PM – Bath time

8:20 PM – 3-part routine: dry off, brush teeth and pee

8:30 PM – get into PJs and clean up toys (set a night-time – not a play-time- scenario)

8:40 PM – Storytime
8:55 PM – Bedtime. Nighttime routine: talk about the day, compliment your child on things he did well, say your ritual goodnight “I love you. Goodnight. Don’t let the bedbugs bite.

Instructions

• Speak in a clear voice: speak at a comfortable loud level, and rate (fast or slow) that your child can follow easily.
• Use natural gestures: use gestures to enhance the message. For example, pointing or holding up objects. Avoid making excessive and unnecessary movements while delivering messages as this may distract your child.
• Give written and verbal instructions: provide written and verbal instructions to help your child in following directions and completing tasks.

Time:

• Avoid fatigue: give your child short activities instead of one long activity. Provide breaks, such as doing 5 star jumps, so your child can move around if needed.
• Response time: give your child more time to come up with answers to verbal questions.

It is important to remember that children react to changes in their environment differently. Different strategies will work for the different needs of each child. It is important that you know your child’s individual profile of strengths and weaknesses.

Most importantly, choose a few strategies and … practice, practice, practice!

Written by Didem Karademir, Speech Pathologist.

Imagine that you are having a conversation with someone but you have not really processed or “heard” what they said? What would you do? Maybe you ask them to repeat themselves, which would help you to process the information. This can happen to all of use sometimes, BUT this is happening constantly for some children. Try to imagine paying attention and learning all day with this difficulty!!

Your child may have adequate hearing (where their ears are sending the sound to their brain) but poor auditory processing (their brain doesn’t match up the sounds properly). This is called Auditory Processing Disorder (APD or CAPD).

But, what is the difference between HEARING and AUDITORY PROCESSING? A common misconception is that APD is a hearing problem. Hearing is when the sounds collected by your ear is sent to the brain. Auditory processing is “what we do with what hear” – so when your brain notices and uses the sound.

Some of the signs of APD to look out for in a child are:

• Forgets what is said in a few minutes
• Easily distracted by background noise
• Does not listen carefully to instructions and often requires directions to be repeated
• Says “what”, “huh?” or “pardon” at least 5 times a day
• Learns better one-on-one

Some suggestions, in the areas of attention, seating, instructions and time, can help children with (C)APD be successful.

Attention

• Speak at eye level: speak at your child’s eye level, get close to your child, and face them to provide clear information
• Use cueing: cue your child to become aware of times when they are not paying attention. Use words, such as “listen”, “are you ready”, and “remember this one”

Seating

• Quiet study/work area: Provide your child with a quiet area for better learning environment.
• Avoid noisy sources: Seat your child away from distracting noise sources. For example, TV, loud music, kitchen appliances when they are trying to listen to the speaker. Seating your child away from windows and doorways will also reduce distraction.

Use daily routines: Use daily schedules to help your child stay focused and organised. Sample Bedtime Routine:

8:00PM – Bath time

8:20PM – 3-part routine: dry off, brush teeth and pee

8:30PM – get into PJs and clean up toys (set a night-time – not a play-time- scenario)

8:40PM – Story time
8:55PM – Bed time. Night time routine: talk about the day, compliment your child on things he did well, say your ritual goodnight “I love you. Goodnight. Don’t let the bedbugs bite.

Instructions

• Speak in clear voice: speak at a comfortable loud level, and rate (fast or slow) that your child can follow easily.
• Use natural gestures: use gestures to enhance the message. For example, pointing or holding up objects. Avoid making excessive and unnecessary movement while delivering messages as this may distract your child.
• Give written and verbal instructions: provide written and verbal instructions to help your child in following directions and completing tasks.

Time:

• Avoid fatigue: give your child short activities instead of one long activity. Provide breaks, such as doing 5 star jumps, so your child can move around if needed.
• Response time: give your child more time to come up with answers to verbal questions.

It is important to remember that children react to changes in their environment differently. Different strategies will work for different needs of each child. It is important that you know your child’s individual profile of strengths and weaknesses.

Most importantly, choose a few strategies and … practice, practice, practice!

Written by Didem Karademir, Speech Pathologist.