Tongue Tie Quick Check Guide

Is Your Child’s Tongue Holding Them Back? Free Parent Assessment Guide

By Dr. Kathleen Schuster, Functional Airway Dentist

⚠️ IMPORTANT DISCLAIMER

This guide is for educational purposes only and does not constitute medical advice. Tongue tie evaluation and treatment should always be performed by qualified healthcare providers. This assessment tool cannot replace professional examination but can help you understand what to look for and ask better questions when consulting with providers. Always seek professional evaluation for any concerns about your child’s development.

The Hidden Connection Most Parents Miss

Here’s what most parents don’t know: Tongue ties aren’t just about the obvious “heart- shaped” tongue. Many restrictions are subtle but significantly impact breathing, eating, sleeping, and even behavior.

If your child struggles with multiple issues that seem unrelated, a tongue restriction might be the hidden common thread connecting everything together.

What Tongue Ties Really Affect

Beyond Speech: The Whole-Body Impact Breathing and Sleep:

Tongue position determines airway space during sleep
Restricted tongues often rest low, blocking airways
Can cause snoring, restless sleep, mouth breathing
May contribute to enlarged tonsils and adenoids Eating and Digestion:
Limited tongue movement makes chewing inefficient
Can cause picky eating, especially with textures
Affects swallowing patterns and digestion
May contribute to reflux and digestive issues Development and Growth:
Tongue guides proper jaw growth during childhood
Restricted tongues can cause narrow palates
May contribute to crowded teeth and orthodontic problems
Affects overall facial development patterns Behavior and Learning:
Poor sleep from breathing issues affects behavior
Frustration from communication difficulties
May contribute to attention and focus problems
Can impact academic performance and social relationships Speech and Communication:
Difficulty with specific sounds (L, R, TH, T, D)
Generally unclear speech for age
Speech therapy progress may be limited
Social confidence affected by communication struggles

Age-Specific Warning Signs Babies (0-12 months):

[ ] Difficulty latching or staying latched while nursing
[ ] Clicking sounds while feeding
[ ] Poor weight gain despite frequent feeding
[ ] Excessive crying that improves when upright
[ ] Reflux or spitting up frequently Toddlers (1-3 years):
[ ] Speech delay or very limited vocabulary
[ ] Extreme pickiness with food textures
[ ] Mouth breathing becoming more noticeable
[ ] Difficulty with cups, prefers bottles/sippy cups
[ ] Frequent falling or clumsiness School Age (4-8 years):
[ ] Speech therapy not making expected progress
[ ] Academic struggles despite intelligence
[ ] Social difficulties around eating or speaking
[ ] Sleep issues affecting behavior and attention
[ ] Complaints of always being tired Older Children (9+ years):
[ ] Persistent speech issues affecting confidence
[ ] Jaw clicking, pain, or tension
[ ] Orthodontic problems (crowded teeth, narrow palate)
[ ] Sleep apnea or loud snoring
[ ] Chronic headaches or neck tension

The 5-Minute Functional Assessment

Now that you understand what tongue restrictions can affect, let’s check your child’s function:

Quick Visual Check

What to look for when your child is at rest:

✅ Normal: Lips together, tongue resting against the roof of the mouth

❌ Concerning: Mouth hanging open, tongue resting low or visible between teeth

Functional Movement Tests

Test 1: Tongue-to-Incisive Papilla Touch Ask your child to touch their tongue tip to the small bump right behind their upper front teeth (called the incisive papilla).

What to watch for:

How much does their mouth have to close to reach it?
[ ] 0-25% closure (normal)
[ ] 25-50% closure (mild restriction)
[ ] 50-75% closure (moderate restriction)
[ ] 75%+ closure or cannot reach (severe restriction)

Red flag: Many kids will try to touch way back on their soft palate instead. Make sure they’re touching the small bump right behind the front teeth.

Test 2: Controlled Side-to-Side Movement (Coordination & Strength Test) Have your child SLOWLY move their tongue from corner to corner while keeping their jaw completely still.

What this test really reveals:

Tongue-jaw coordination: Can the tongue work independently of the jaw?
Tongue strength: Is the tongue strong enough to reach corners without help?
Compensation patterns: Does the jaw move to help the tongue reach?
Muscle control: Can the child control the movement smoothly? What to watch for:
[ ] Smooth, controlled movement with jaw staying still (good coordination & strength)
[ ] Tongue shaking, jumping, or tremoring during movement (weak or uncoordinated tongue)
[ ] Jaw moving or deviating to help tongue reach corners (compensation for weak tongue)
[ ] Cannot reach one or both corners with jaw still (restriction OR weakness)

Important: Movement must be SLOW and controlled. Fast movements can mask both restrictions and weakness. Even if the tongue can stretch to reach the corners, this test shows whether it’s strong and coordinated enough to do its job properly.

Test 3: Posterior Elevation Test Have your child open their mouth wide and say “UNC” (like the end of “hung”).

What to watch for:

[ ] Back of tongue elevates easily while mouth stays open (normal)
[ ] Difficulty elevating back of tongue with mouth open (posterior restriction)
[ ] Mouth closes significantly during “UNC” sound (restriction)
[ ] Cannot make clear “UNC” sound with mouth wide (restriction)

Test 4: “Clicking” Sound Ask your child to make a clicking sound with their tongue (like a horse).

✅ Normal: Clear, crisp clicking sounds

❌ Concerning: Can’t make the sound, very quiet clicks, or difficulty repeating

Understanding Your Assessment Results

Now that you’ve completed the four functional tests with your child, it’s time to understand what the results mean. Each test reveals different aspects of tongue function, and together they give you a comprehensive picture of whether restrictions might be affecting your child’s development.

How to Score Your Child’s Assessment

For each test, give your child a score from 0-3:

Test 1: Incisive Papilla Touch

0 points: Reaches easily with 0-25% mouth closure
1 point: Reaches with 25-50% mouth closure
2 points: Reaches with 50-75% mouth closure
3 points: Needs 75%+ mouth closure or cannot reach at all Test 2: Side-to-Side Movement (Coordination & Strength)
0 points: Smooth, controlled movement, jaw stays completely still, no shaking
1 point: Slight shakiness OR minimal jaw movement (but not both)
2 points: Noticeable shaking/tremoring AND/OR obvious jaw compensation
3 points: Cannot reach corners, severe shaking, major jaw deviation, or gives up Test 3: Posterior Elevation (“UNC” Test)
0 points: Says “UNC” clearly with mouth wide open
1 point: Says “UNC” but mouth closes slightly
2 points: Difficulty with “UNC” sound, mouth closes significantly
3 points: Cannot make “UNC” sound or mouth must close completely

Test 4: Clicking Sounds

0 points: Clear, crisp clicks, can repeat easily
1 point: Clicks are present but quiet or inconsistent
2 points: Very difficult to make clicking sounds
3 points: Cannot make clicking sounds at all Your Child’s Total Score

Add up all four test scores:

Test Your Child’s Score Incisive papilla touch /3

Side-to-side movement___ /3

Posterior elevation	/3
Clicking sounds	/3
TOTAL	/12

What Your Score Means:

0-2 points: Minimal restriction – Continue monitoring, reassess in 6 months 3-5 points: Mild restriction – Consider professional evaluation within 3-6 months

6-8 points: Moderate restriction – Professional evaluation recommended within 1-2 months 9-12 points: Severe restriction – Seek professional evaluation within 2-4 weeks

Additional Red Flags:

[ ] Tongue shaking or tremoring during any movement
[ ] Jaw deviation or movement to compensate for tongue limitations
[ ] Child becomes frustrated or gives up during testing
[ ] Significant difference between right and left side movement

Understanding Tongue Function vs. Tongue Freedom It’s Not Just About Restriction – It’s About Function

Many parents think tongue ties are only about whether the tongue can move freely. But there’s a bigger picture: Can the tongue actually DO its job effectively?

Two different problems can affect your child:

Structural Restrictions:
- Tight tissue under the tongue preventing normal movement
- Tongue can’t reach where it needs to go
- Classic “tongue tie” that most people think of
Functional Limitations:
- Tongue might move freely, but the oral structure makes function difficult
- High, narrow palate makes it hard for tongue to reach and create suction
- Weak tongue muscles that can’t perform their jobs effectively
- Poor coordination between tongue and jaw movements

The Real-World Impact: Even if your child’s tongue can physically reach the roof of their mouth, if the palate is too high and narrow, they’ll struggle with:

Creating proper suction for swallowing
Maintaining tongue position during sleep
Efficient chewing and food processing
Clear speech sound production

This is why functional assessment matters more than just checking if the tongue “looks restricted.”

Why “It Doesn’t Look Tight” Doesn’t Tell the Whole Story

Many children with significant functional problems have tongues that move freely but can’t function effectively. What matters is how well the tongue can DO its job, not just how it appears or how far it can stretch.

Hidden Functional Problems:

High, Narrow Palate Issues:

Tongue may reach the roof of mouth but can’t create effective suction
Swallowing becomes inefficient even with normal tongue mobility
Sleep breathing affected because tongue can’t maintain proper position
Speech clarity suffers despite tongue reaching correct spots Weak Tongue Muscles:
Tongue moves through range of motion but lacks strength for function
Cannot maintain positions needed for proper breathing or swallowing
Compensates by using jaw movement instead of tongue strength
Fatigues quickly during eating or extended speaking Poor Coordination Patterns:
Tongue and jaw move together instead of independently
Cannot perform precise movements needed for clear speech
Develops compensatory patterns that become habitual
May look normal during casual observation but fails during skilled tasks Structural Limitations:
Posterior (back) tongue restrictions that aren’t visible
Tongue can elevate but cannot create the suction needed for function
May have adequate movement but inadequate strength or endurance When Visual and Functional Don’t Match

Mild-looking restriction, major functional impact:

Child may have significant speech, eating, or breathing issues
Often told “it’s not tight enough to cause problems”
Requires provider who understands functional assessment Obvious-looking restriction, minor functional impact:
Some children compensate well despite visible restrictions
May still benefit from treatment for long-term health
Needs individual assessment, not just appearance

Red Flags That Require Professional Evaluation Immediate Concerns:

Any breathing difficulties during sleep
Severe feeding problems affecting nutrition
Speech delays significantly impacting communication
Academic or behavioral problems related to sleep/attention Schedule Professional Assessment:
Multiple warning signs from age-specific lists
Family history of tongue ties or similar issues
Other providers have noted tongue position concerns
Gut feeling that something isn’t right Provider Red Flags to Avoid:
“They’ll grow out of it”
“It’s not tight enough to cause problems”
Only does visual examination without functional testing
Dismisses parent concerns about sleep, eating, or behavior

What Happens Next?

If You Found Concerning Signs:

Step 1: Document Everything

Take photos/videos of tongue movement
Note patterns of feeding, speech, sleep, and behavior
Track when problems are better or worse
Prepare questions for provider consultations

Step 2: Learn About Solutions Many functional issues can be improved through:

Myofunctional exercises and therapy
Environmental and dietary changes
Proper breathing training
Professional evaluation and potential treatment

Step 3: Find the Right Support

Providers who understand functional assessment
Comprehensive approach addressing multiple symptoms
Coordination between different specialists
Family-centered care that includes education and support

Your Child’s Development Can’t Wait

Early intervention makes everything easier. The younger your child when restrictions are addressed, the more dramatic and lasting the improvements can be.

Remember:

You’re not imagining things if multiple signs resonate
Trust your observations about your child’s struggles
Functional problems deserve functional solutions
You are your child’s best advocate

Ready to Help Your Child Reach Their Full Potential?

This quick assessment gives you the foundation to understand what to look for, but getting real solutions requires knowing HOW to help your child develop proper function.

Want to start helping your child immediately while you research providers?

Get “Getting Your Kids Started with Myo & Proper Growth” – your practical guide to:

✅ Simple exercises you can start today to improve tongue function

✅ Growth-supporting activities that help jaw development

✅ Breathing training that works for all ages

✅ When to seek professional help and how to find the right providers

✅ Connecting to advanced programs like MyoFit Pro for structured progress

Because your child’s development can’t wait for “wait and see” approaches.

Questions? Connect with us:

� info@magnoliaridgedentistry.com

I Follow @magnoliaridgedentistry for more parent education

Important Disclaimer: This guide is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare providers for professional evaluation and treatment decisions. Individual situations vary, and this assessment tool cannot replace professional examination.

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Tongue Tie Quick Check Guide

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