Saturday, March 31, 2012

Post Pediatrician Visit Update (tongue-tie / mouth breathing)

As such things often are, Michael's pediatrician visit was oddly anti-climactic. I think I tend to build doctor visits up in my head as Super-Important-Life-Altering-Decision meetings when often they are pretty routine. Our pediatrician was -completely- uninterested in the tongue-tie. She had been educated that clipping a tongue-tie rarely fixes speech problems and didn't want to give it further thought.

I've been thinking about why the tongue-tie bothers me even though I know that Michael can produce 4/6 alveolar sounds. It bugs me that he cannot stick his tongue out horizontally and cannot lift his tongue up on command. If it isn't the tongue-tie restricting that movement I want to know what is. Is it weakness? If so, what is the origin of the weakness? Can habitual mouth breathing result in low enough tone to impact tongue strength? Our pediatrician was uninterested. She said, some people can curl their tongue up. Some can't. Perhaps Michael just can't lift his tongue. I have to say, I was unsatisfied.

She was, however concerned about the mouth breathing. After examining him, she declared his tonsils of normal size. She can't see his adenoids though and wants him to see an ENT to get an opinion about the tonsils/adenoids/sinuses. She said I could ask the ENT about the tongue-tie if I wanted another opinion.

Her bet however, based upon my husband's history of needing allergy shots as a child and Michael's history of eczema, is allergies. She referred us to an allergist and wants him to take Flonase at night and Claritin in the morning. The receptionist for the allergist told me that they always allocate time for skin testing even when scheduling an initial appointment so I need to pull him off the Claritin 5 days before the appointment just in case the doctor decides he needs skin testing.

Hmm. Skin testing my 4 year old. That sounds... interesting. Other than educating him before hand, bringing something distracting to watch on the iPad, and some super special treat for when he's done does anyone have any suggestions for what to expect or how to handle it?

Presumably, when we figure out why Michael can't breathe through his nose and address the underlying issue the mouth breathing will cease. Perhaps some improved tongue strength and mobility will follow? It'll be two weeks or more before we get through the specialist appointments and begin to get some answers (I hope). I sure do hate waiting.


  1. Is there an ENT/Allegist around you? My daughter- also a mouth breather - went to one and he did both the allergy testing (skin) and x-rayed her to see the adenoids (instead of scoping her) and came to the determination that she had both seasonal allergies and enlarged adenoids and turbinates. Last year (age 5) she had her adenoids removed and her turbinates reduced and now is able to be off all allergy meds with the exception of the spring season. Since the surgery, she has had only 2 stuff noses and they were cleared within a week or so - no more lingering runny nose that she seemed to have for 3+ years.

    My husband is tongue tied - he never had it clipped. He did have speech issues growing up, but now spends his day on the phone at work, so he speaks normally. He can't curl his tongue or whistle, but it works.

    Good luck! I agree - bring the ipad for distraction!

  2. A friend's baby was having trouble latching on while breastfeeding. Once she had the frenulum clipped, presto, problem solved. Apparently, midwives used to have a curved fingernail to do it because it was so routine. Modern doctors don't seem to know as much about it.

  3. A little boy I used to work with had a mom who was a nurse. His sister had eczema, and the mom put her children on fish oil. The eczema went away totally, and interestingly, my student's attention span increased. I asked the mom what she did, jokingly, because his behavior was so different, and fish oil was her response. It was some company from Norway, it was a liquid for children without the bad taste. I have been convinced that omega-3's are something our body needs and doesn't get.

  4. I would spend more time looking into tongue tie. I always have my parents do research, but leave them with this: Typically, if a kiddo is going to have a tongue-tie clipped it is within the first week after birth. It is surgery, with anesthetic. It's not all that minor.
    Perhaps I'm biased, I am tongue tied, but I never needed speech or feeding therapy. If a child can produce their speech sounds, and it does not effect feeding, I lean toward not clipping it. Do your research and then make an educated decision.
    M.A., CCC-SLP


  6. How did the skin-testing go? How about Michael’s tongue-tie problems? My niece is also tongue-tied but as she ages, her frenum comes loose by itself. She did not have therapy but she’s speaking clearly now. Since Michael is still young, he can still outgrow those problems. Besides, he has a mother like you who knows which things to worry about so I bet Michael will grow up well.

    Chalice Lindgren

  7. As an SLP and mom of a kiddo with severe ties (that got revised at age 2 by ENT) I have done a significant amount of research into tongue and lip ties. A tongue tie can cause obstructive sleep apnea. I recently took a course at the ASHA convention that discussed TOT (Tethered Oral Tissue). I would encourage you to do more research in this area.


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