Wednesday, July 23, 2008

Tongue tied (UPDATED)

Yesterday was Thomas' appointment with Dr. Jahng (an Ear, Nose, and Throat specialist/surgeon) to determine if his speech delay is being caused by a short frenulum. The verdict from the doctor: yes.

I liked the doctor. When I called for an appointment they scheduled it for the next day. We arrived on time and were seen less than five minutes later. The doctor was kind, gentle, competent, and readily answered all my questions. Although the referral from Thomas' pediatrician stated that they had ruled out hearing issues, Dr. Jahng checked his ears anyway before even looking at his tongue. I appreciated the thoroughness.

So the diagnosis is speech impairment due to Ankyloglossia. Dr. Jahng treats this by doing surgery under light general anesthesia. This worries me a bit - general anesthesia in a 17 month old just sounds scary - but he says that it is safe. He does not treat this condition by "clipping" the frenulum in office, because he says that doing it that way risks worse problems due to improper healing (fusion of the two parts, etc.) Surgery allows him to take his time, do it right, and suture both sides to minimize risks of future problems. This makes sense to me.

Part of me wants to say "we love our pediatrician, who referred us to Dr. Jahng, who seems entirely competent, so let's go ahead and act on his recommendation." This is especially true since tongue-tie runs in the family (Gabe is tongue tied, spoke very late, and feels that it affects his speech even now) and Gabe feels that it would be best to free Thomas from that difficulty. I'm also leaning this way because it seems rather awful to just leave a bright child frustrated and unable to communicate well because of a condition that is very fixable.

Still, this surgery is pretty controversial, at least in the world of the internet. Look it up and you'll find LOTS of people against it, including doctors who think that you should "wait and see", as the child may outgrown the condition by age six. Age six? What about talking? I don't think I can cope with a preschooler who communicates via signing and "nanana AHHHHHH!" Then there are the doctors who say that it has absolutely nothing to do with speech impairment, and that two year olds who are tongue-tied and don't talk are just going at their own pace. I'm not sure I buy that idea, especially given Gabe's history.

Sigh. Surgery is scary, and I can definitely understand not wanting to subject your child to it if it isn't necessary. It's just that tricky question of "necessary".

The referral paperwork is in process right now. Gabe and I will probably discuss it some more, but at this point I'm guessing we'll go ahead and do it.

Updated to add these links because I found them the most helpful:

Bandolier: Evidenced based thinking on healthcare: Ankyloglossia

Tongue-Tie: from confusion to clarity


Elena said...

Wow. May God give you wisdom to know how to care for this precious child with whom He has entrusted you, and confidence and assurance as you proceed with whatever plan you choose under His guidance.

Ashley said...

I would trust the Dr. more than the internet. If you look up Autumn's condition on the internet (NF) you will see a lot of scary things. Only the extreme stuff is on the internet because why would you post something about someone who has a fairly mild condition or an easy surgery. Hunter was under general anesthesia at 3 weeks old, Autumn was put under at 2 years old so I wouldn't worry about him being too young.

Amber said...

I can definitely understand your concerns about putting him under, but the doctor's reasoning makes a lot of sense. And it seems ridiculous to me to wait until he's six or so to decide what to do... there's so much development that happens in that period of time!! This is purely ancedotal, but I knew a kid (a younger brother of a friend at school) who didn't have the surgery until he was 6 and while it did make a big difference for him after he had been in speech therapy for awhile, it took a lot longer for the emotional impacts of being hard to understand for so long to work themselves out.

I'm glad though that you've found a doctor you like - that has to make things easier to think about!

JoAnn said...

If it is affecting his speech, I'd say do it. I have one child that is tongue-tied. Although the dentist says he can hear it, no one else can so we didn't do anything about it. I have another child that had a speech delay (for a different reason). His frustration at being unable to communicate led him to lash out in anger: biting (drawing blood!), kicking, hitting, trying to gouge eyes. When we finally figured out the cause and corrected it, he quickly improved. Now he's completely caught up with articulation but still has difficulty with other communication issues. I think his issues are related to him being unable to communicate when he was younger. It's hard to correct it now that he's resigned to being misunderstood. His usual response is, "Just forget it," but then later he lashes out in anger from not being listened to. In my opinion, it would be better to avoid possible problems if you can.

Becks said...

I'm tongue tied! My mom ABSOLUTELY REFUSED to fix it when I was a baby - she couldn't imagine inflicting pain on her newborn. I have mixed feelings about it - it does make it harder to talk, but I don't think it inhibited by language acquisition because I was the most talkative child. It really bothered me when I was younger though, it used to be painful when I talked too much, and I used to stick my tongue out as far as I could all the time to "stretch" it. When I was about 13 I actually took a pair of scissors to it (do not recommend!). I think it has stretched out since, otherwise I would elect for surgery.